Cases reported "Lupus Nephritis"

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1/4. Pneumothoraces complicating systemic lupus erythematosus with nephritis.

    pneumothorax is an infrequently reported complication of systemic lupus erythematosus (SLE) and carries with it a grave prognosis. We report a patient with SLE and nephritis who developed pneumothorax that responded to aggressive and prolonged therapy. Surgical management with prolonged evacuation, judicious immunosuppression, and aggressive diagnosis and treatment of infection can improve the outcome for these patients.
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2/4. Lupus vasculopathy combined with acute renal failure in lupus nephritis.

    Several risk factors have been associated with the prognosis of lupus nephritis. However, few studies have focused on renal vascular lesions (such as thrombi due to immune complexes) as a prognostic factor in this disease. Here we present a case of systemic lupus erythematosus (SLE) in a 12-year-old girl who exhibited acute renal failure and severe hypertension on admission. Renal pathology findings included diffuse proliferative glomerulonephritis (class IVb) and lupus vasculopathy (LV) with immune complex deposition within glomerular capillaries and the preglomerular arteriolar lumen. Her clinical condition deteriorated rapidly, even after cyclophosphamide and methylprednisolone pulse therapy. It improved after 5 days of plasmapheresis and remained stable for up to 6 months under regular treatment. We suggest that renal biopsy performed early in SLE patients with renal involvement should be studied carefully for the presence of vascular lesions. Additionally, plasmapheresis can be considered in patients with LV refractory to other modalities of therapy.
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3/4. Evaluation of lupus nephritis during pregnancy by renal biopsy.

    patients with lupus nephritis frequently exhibit increasing proteinuria, hypertension and deterioration of renal function due to either active lupus nephritis, chronic lupus nephritis and/or superimposed preeclampsia during pregnancy. Percutaneous renal biopsies were therefore performed in 3 women with systemic lupus erythematosus during pregnancy and immediately postpartum in a fourth woman to evaluate their renal disease during pregnancy. Mean serum creatinine at renal biopsy was 2.9 mg/dl, with a mean creatinine clearance of 66 ml/min and protein excretion of 5.3 g/day. All patients had grade IV lupus nephritis and received pulse methylprednisolone immediately; 3 received cyclophosphamide. All 3 patients with crescent formation developed endstage renal disease within 3 years. The fourth patient has normal renal function 3 years after biopsy. Percutaneous renal biopsies during pregnancy in women with lupus nephritis provide an accurate histopathologic diagnosis and are important in providing appropriate therapy, counseling and prognosis.
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4/4. cyclosporine in the treatment of lupus nephritis including two patients treated during pregnancy.

    Although the combination of corticosteroids and intermittent pulse doses of cyclophosphamide has considerably improved the prognosis of lupus nephritis, there are still some unanswered questions about this regimen, in particular its use in pregnancy. As cyclosporine appeared to be effective in experimental models of lupus nephritis, some studies have been performed using this drug in patients with lupus nephritis. However, there was no mention of pregnancy in these patients. In view of the large experience with cyclosporine during pregnancy in renal transplant recipients and its established safety concerning teratogenicity, we decided to treat 5 young female patients having lupus nephritis with cyclosporine in combination with low-dose prednisone. Two of these patients were pregnant and both had successful delivery. During the follow-up period of 7-35 months there were no signs of flare-up of the lupus nephritis, except in one case where the patient accidentally discontinued the medication. In a second patient there was a slight increase of the serum creatinine level. Otherwise, the renal and immunological parameters improved or remained stable during the observation period. hypertension developed in 3 cases. These preliminary results support the further evaluation of cyclosporine as an alternative to cyclophosphamide in the treatment of lupus nephritis, especially in young female patients with pregnancy or at high risk for pregnancy.
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