LAUSR

and maternal death (4%). The worst outcomes were recorded for women with active vasculitis at conception and high rates of relapse with inactive disease at conception were also reported. Active vasculitis during pregnancy creates treatment dilemmas, as many first-line agents are unsafe. Historically, patients received CYC and glucocorticoids as remission induction, although CYC is not recommended in pregnancy. More recently, RAVE and RITUXVAS demonstrated that RTX is non-inferior to CYC with similar remission rates and adverse events in patients with ANCA-positive vasculitis. Guidelines for ANCA-positive disease are also followed for ANCAnegative vasculitis despite relative lack of evidence and successful outcomes are reported. The proposed mechanism for this is through an indirect effect on autoreactive T-cells remote to the kidney. A small retrospective study looking at the use of RTX in pregnancy showed comparable teratogenicity rates compared with the general population, lending support for its ongoing use. Neonatal CD20+ B-cell depletion was observed in 7% of cases. Glucocorticoids are regarded as safe in pregnancy, as are azathioprine, plasma exchange and immunoglobulins. Renal vasculitis in pregnancy deserves the attention of nephrologists and obstetricians. Awareness of the increased maternal/foetal risks, as well as the implications of pregnancy on the treatment of active vasculitis is integral. Pregnancy counselling should be offered to all patients; however, it should be remembered that whilst these pregnancies are complicated and high-risk, they can occasionally be carried to term.