title: Pregnancy outcomes in a patient with Sjögren's disease with renal involvement.
abstract: BACKGROUND
  Maternal and fetal outcome in pregnancy with renal failure is unpredictable, where each condition can adversely affect the other. We present a case of steroid sensitive Sjögren's nephritis worsened by pregnancy, demonstrated over the course of multiple pregnancies and investigated the aetiology.
  
  
  METHODS
  A 28-year-old nullipara with a diagnosis of primary Sjögren's syndrome presented with a deterioration of renal function. A diagnosis of secondary tubulo-interstitial nephritis was made on renal biopsy. Her first pregnancy ended in the second trimester with a decision to deliver a female infant at 27 weeks due to worsening maternal renal function. Renal function improved immediately. A second pregnancy ended in a first trimester miscarriage. The third and fourth pregnancies delivered male infants at 35 and 34 weeks, with worsening renal function in each pregnancy, reaching end stage. Repeat biopsy showed extensive glomerulosclerosis and male cells were identified.
  
  
  CONCLUSIONS
  This case of Sjögren's syndrome with renal disease demonstrated the increased risk of fetal and maternal adverse pregnancy outcomes. Renal function worsened in each pregnancy and progressed to end-stage renal disease. Fetal microchimerism offers an interesting mechanism for our patient's renal failure and its apparent relationship to her pregnancies.
authors.affiliation: Department of Acute Medicine, Princess Royal University Hospital, South London Healthcare Trust, London, UK.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Republic of Ireland.
authors.forename: Keelin
authors.initials: K
authors.lastname: O'Donoghue
authors.affiliation: Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Republic of Ireland.
authors.forename: Uzma
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Department of Nephrology, St George's Healthcare Trust, London, UK.
authors.forename: Debasish
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Department of Acute Medicine, Princess Royal University Hospital, South London Healthcare Trust, London, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Banerjee
keywords: Maternal-fetal medicine; immunology; nephrology; rheumatology