Exploring the Link Between Low Albumin in Lupus and Pregnancy Outcomes

Q: Exploring the Link Between Low Albumin in Lupus and Pregnancy Outcomes

Hello, thank you for your inquiry. <br>Here are my responses：<br>1) In 2017, starting from June, my proteinuria fluctuated between negative and positive, eventually showing ++ and +++. <br>However, at that time, my albumin level was still at 4.2. <br>There was a year when I did n

The correlation between low albumin levels in systemic lupus erythematosus (SLE) and pregnancy/abortion, along with proteinuria and the calculation method?

Dear Dr.
Gao,
Thank you for your prompt response to my inquiry regarding #186219.
I have another question related to lupus erythematosus that I would like to ask you.

1) In June 2017, I began experiencing proteinuria that fluctuated between negative and positive, eventually reaching + and +++.
However, my albumin levels were still at 4.2 at that time.
During that year, I was abroad and did not have urine or blood tests done, and I also accidentally became pregnant, which led me to visit an obstetrics clinic for medication and a surgical abortion (if I recall correctly, it was performed around six weeks).
The following year, in late October 2018, I returned to the rheumatology clinic, where my proteinuria continued to fluctuate between negative and +++.
By mid-2019, I rarely had negative results, with most being ++ and +++.
My albumin levels remained low, ranging from 2.6 to 3.6, occasionally reaching 3.7, until my tests in July of this year showed proteinuria at negative and albumin at 4.0.
I would like to ask if the decline in albumin and its inability to recover could be related to my previous pregnancy or abortion? Or could it be due to stress and dietary habits while abroad, or perhaps a reduction in medication due to my condition? Or is it simply a worsening of lupus erythematosus symptoms?
2) I would like to confirm the calculation method for proteinuria with a + sign.
Previously, when I asked a doctor during a consultation, he mentioned that a 24-hour proteinuria of 30-40 mg is considered +, and over 60 mg is ++.
However, I have been unable to find any information online that supports this classification.
Therefore, I would like to confirm this with you.
Thank you, Dr.!
Best regards,
Ann

Ann, 30~39 year old female. Ask Date: 2022/09/07

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1) In 2017, starting from June, my proteinuria fluctuated between negative and positive, eventually showing ++ and +++.
However, at that time, my albumin level was still at 4.2.
There was a year when I did not undergo urine and blood monitoring due to being abroad, and during that time, I accidentally became pregnant and went to an obstetrics and gynecology clinic for medication and a surgical abortion (I believe it was performed around six weeks).
Later, in late October 2018, I returned to the rheumatology clinic, and my proteinuria continued to fluctuate between negative and +++.
By mid-2019, I rarely had negative results, mostly showing ++ and +++.
My albumin levels remained low, ranging from 2.6 to 3.6, occasionally reaching 3.7, until my tests in July of this year showed proteinuria at negative and albumin at 4.0.
I would like to ask if the decline in albumin and its inability to recover could be related to my previous pregnancy or abortion? Or could it also be due to stress and dietary neglect while abroad, or perhaps a reduction in medication due to my condition? Or is it simply a worsening of lupus erythematosus symptoms? --> The proteinuria results are qualitative tests and not quantitatively measured by machines, so the corresponding protein levels are often inaccurate.
I recommend discussing with your physician whether a quantitative urine protein test can be arranged to confirm the protein levels, which would serve as a reference for treatment and diagnosis.
The albumin levels in the blood are not related to previous pregnancy or abortion but are associated with your nutritional status and the function of various organs, particularly the kidneys, liver, and heart.
Regarding the kidneys, it is essential to consider the disease activity of lupus erythematosus.
Stress, self-medication, and contraceptive use can all affect the control of lupus, so please be sure to discuss this with your physician and follow the treatment plan.
2) I would like to ask the physician about the calculation method for proteinuria +.
I previously asked my doctor during a consultation, and he told me that a 24-hour urine protein level of 30-40 is considered +, and 60 or above is ++.
However, I have not been able to find any information online that supports this classification.
Therefore, I would like to confirm this with the physician.
--> As mentioned, the proteinuria results are often inaccurate, and factors such as hydration and diet can influence them.
It is recommended to directly measure the urine protein levels using a machine, which can be arranged during outpatient visits for a more objective assessment.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is concerned about your health.

Reply Date: 2022/09/07

More Info

The relationship between low albumin levels in patients with lupus and pregnancy outcomes is a complex and multifaceted issue. Lupus, or systemic lupus erythematosus (SLE), is an autoimmune disease that can significantly impact various bodily systems, including the kidneys, which is often reflected in proteinuria (the presence of excess protein in urine) and low serum albumin levels.
1. Impact of Low Albumin on Pregnancy: Low albumin levels can indicate a variety of underlying issues, including kidney dysfunction, which is particularly relevant in lupus patients. In the context of pregnancy, low albumin can lead to complications such as preeclampsia, gestational hypertension, and increased risk of preterm birth. The presence of proteinuria is also a concerning sign, as it may indicate nephritis or other renal complications associated with lupus. These conditions can adversely affect both maternal and fetal health, leading to poorer pregnancy outcomes.

2. Possible Causes of Low Albumin: Your question regarding whether the decline in albumin levels could be related to your previous pregnancy or abortion is valid. While pregnancy can place additional stress on the body and exacerbate underlying conditions, it is also possible that factors such as dietary changes, stress, or medication adjustments during your time abroad could have contributed to fluctuations in your albumin levels. Lupus itself can also have periods of exacerbation and remission, which may correlate with changes in your lab results.
3. Monitoring and Management: Given your history of fluctuating proteinuria and albumin levels, it is crucial to maintain regular follow-ups with your healthcare provider. They may recommend additional tests to monitor kidney function and assess the activity of your lupus. This is especially important if you are considering future pregnancies, as preconception counseling can help optimize your health and reduce risks.

4. Understanding Proteinuria Measurement: Regarding the measurement of proteinuria, it is essential to understand that the "+" signs you mentioned are qualitative assessments and do not provide a precise quantification of protein levels. The 24-hour urine protein test is a more accurate method for assessing proteinuria. Generally, a 24-hour urine protein level of 30-300 mg is considered microalbuminuria, while levels above 300 mg indicate significant proteinuria. Your healthcare provider can provide you with specific guidance on interpreting these results and their implications for your health.

5. Conclusion: In summary, low albumin levels in lupus patients can have significant implications for pregnancy outcomes, and it is essential to consider various factors that may contribute to these changes. Regular monitoring, a healthy lifestyle, and open communication with your healthcare team are vital in managing your condition effectively. If you have concerns about your albumin levels or any other symptoms, do not hesitate to reach out to your healthcare provider for personalized advice and management strategies.

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