Biopsy-Confirmed Lupus Nephritis with Advanced Sclerosing Disease Managed with Overlap Treatment. A Case Report
DOI:
https://doi.org/10.60787/tnhj.v24i2.828Keywords:
case report, lupus nephritis, systemin lupus erythematosus, remission, relapse, histology, haemodialysis, kidney biopsyAbstract
Background: Lupus nephritis, complicating systemic lupus erythematosus, can progress to end-stage kidney disease, with a poor prognosis. Histological diagnosis is essential in formulating an effective treatment regimen particularly with symptom overlap.
Method: We highlighted the role of a histological diagnosis in the management of Lupus nephritis with complex overlapping symptoms according to approved treatment protocol.
Result: She was anemic and the histological diagnosis was class VI lupus nephritis. She was managed using an overlapping treatment spanning classes IV – VI, with haemodialysis (HD), mycophenolate mofetil, methylprednisolone and diuretics based on heightened disease activity and extrarenal manifestations. Using the WHO and the International Society of Nephrology/Renal Pathology Society revised guidelines, KDIGO recommended haemodialysis for classes III, IV, and V with nephrotic syndrome, in addition to high dose corticosteroids, cyclophosphamide/MMF (induction therapy), and low dose corticosteroid/MMF for maintenance therapy. The disease went into remission, and she continued outpatient HD.
Conclusion: The case highlights the place of histological diagnosis in managing LN associated with complexities of staging and symptoms-overlap to achieve optimal results.
References
Pons-Estel GJ, Ugarte-Gil MF, Alarcón GS. Epidemiology of systemic lupus erythematosus. Expert Rev Clin Immunol. 2017; 13(8):799-814. doi: 10.1080/1744666X.2017.1327352.
Fatoye F, Gebrye T, Mbada C. Global and regional prevalence and incidence of systemic lupus erythematosus in low-and-middle income countries: a systematic review and meta-analysis. Rheumatol Int. 2022; 42(12):2097-2107. doi: 10.1007/s00296-022-05183-4.
Green MR, Kennell AS, Larche MJ, Seifert MH, Isenberg DA, Salaman MR. Natural killer T cells in families of patients with systemic lupus erythematosus: Their possible role in regulation of IgG production. Arthritis Rheum 2007; 56: 303–310.
Devadass CW, Mysorekar VV, Eshwarappa M, Mekala L, Siddaiah MG, Channabasappa KG. Clinical features and histological patterns of lupus nephritis in a single center of South India. Saudi J Kidney Dis Transpl. 2016; 27(6):1224-1230. doi: 10.4103/1319-2442.194657.
Adelowo OO, Oguntona SA. Pattern of systemic lupus erythematosus among Nigerians. Clin Rheumatol. 2009; 28(6):699-703.
Parikh SV, Nagaraja HN, Hebert L. et al. Renal flare as a predictor of incident and progressive CKD in patients with lupus nephritis. Clin J Am Soc Nephrol 2014; 9: 279–284
Bajema IM, Wilhelmus S, Alpers CE, Bruijn JA, Colvin RB, Cook HT, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018; 93(4):789-796. doi: 10.1016/j.kint.2017.11.023.
Uduagbamen PK, Salako BL, Hamzat MA, Kadiri S, Arogundade FA. Kidney Function in Frequent Users of Non-steroidal anti-inflammatory drugs (NSAIDs). Open J Int Med 2020; 10(1): 69-82. doi: 10.4236/ojim.2020.101007
KDIGO clinical practice guideline for glomerulonephritis. Kidney Int suppl. 2012 2(2):139-274
Malvar A, Pirruccio P, Alberton V, Lococo B, Recalde C, Fazini B, et al. Histologic versus clinical remission in proliferative lupus nephritis. Nephrol Dial Transplant. 2017; 32(8):1338-1344. doi: 10.1093/ndt/gfv296.
Rovin BH, Parikh SV, Alvarado A. The kidney biopsy in lupus nephritis: is it still relevant? In: Ginzler EM, Dooley MA (eds). Systemic Lupus Erythematosus. Philadelphia: Elsevier, 2014, pp. 537–552
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