Table 3.

An overview of the impact of glomerular disease in women

Aspect of health	Glomerular etiology	Impact	Details
Disease prevalence	All	Increased opportunities for diagnosis in women	Higher use of primary care by women, with opportunities for urine and blood pressure screening.
	SLE	Female preponderance	Hypothesized modulation of immune system by sex steroids.
	Preeclampsia	Affects 3%–5% of women	Estimated to be the most common glomerular disease worldwide. Prevalence underestimated by histological data as biopsy is rare.
Fertility	All	Reduced	Effects of CKD on reproductive hormone profile. Voluntary childlessness may contribute.
	SLE	Reduced	Active disease, anti–corpus luteum antibodies, endometriosis, reduced ovarian reserve.
	SLE, vasculitis, rapidly progressive GN	Reduced	Dose- and age-dependent premature ovarian failure secondary to cyclophosphamide. Consider fertility preservation in premenopausal women.
	All	Need for artificial reproductive techniques	Risk of VTE and ovarian hyperstimulation. Single-embryo transfer in CKD.
Contraception	All	Required with teratogenic medication	Includes mycophenolate, cyclophosphamide, methotrexate. Progesterone-only preparations are safe and effective in SLE and CKD.
Pregnancy	All	Remove teratogens in advance of pregnancy	Advise 3 months for washout and to ensure disease stability. CNI, Aza, HCQ, steroids are considered safe for pregnancy.
	All	Adverse pregnancy outcomes	Increased risk with CKD, hypertension, and proteinuria.
	All	Preeclampsia	Prophylaxis with low-dose aspirin (75–150 mg). No diagnostic criteria for superimposed preeclampsia. Clinical overlap with GN signs and symptoms. Surveillance by an expert clinical team. Future use of anti/angiogenic biomarkers predicted.
	All	VTE risk in pregnancy increased if proteinuria	Threshold for LMWH prophylaxis unknown.
	All	BP	Aim <140/90 mm Hg.
	All	Vitamin D deficiency	Replacement if 25-hydroxyvitamin D is <20 ng/ml (50 nmol/l). Continue activated vitamin D analogs as pre-pregnancy.
	All	Anemia	Increased erythropoietin requirement. May need synthetic replacement.
	All relapsing-remitting GN	Disease activity associated with adverse pregnancy outcome	Aim remission for 6 months before conception. HCQ for all women with lupus nephritis.
	SLE	Risk of flare	Risk of ∼15% during pregnancy and ∼15% in 1-year postpartum.
	SLE	Placental transfer of maternal antibodies	Risk of neonatal cutaneous lupus and congenital heart block with anti SSA (Ro)/SSB (La). Thromboprophylaxis in antiphospholipid syndrome.
	Membranous	anti-PLA2R	Role in maternal diagnosis/prognosis and fetal effects unknown.
Long-term outcomes	Membranous and FSGS	Slower rate of decline in renal function	Lower levels of BP and proteinuria in women contribute. Additional protective effect also measured in women.
	All with a history of preeclampsia	Increased future vascular and renal disease risk	Causality versus association not determined.
	IgA	Renal disease progression	Not affected by pregnancy if renal function preserved.

AZA, azathioprine; BP, blood pressure; CKD, chronic kidney disease; CNI, calcineurin inhibitor; FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; HCQ, hydroxychloroquine; PLA₂R, anti–phospholipase A2 receptor antibodies; LMWH, low molecular weight heparin; SLE, systemic lupus erythematosus; SSA/SSB, Sjögren syndrome antibodies; VTE, venous thromboembolism.