A case complicated with SLE during maintenance hemodialysis.
A 40-year-old woman suffered from toxemia of pregnancy in 1977 and was admitted to hospital. Thereafter, she developed nephrotic syndrome, underwent a renal biopsy, and a diagnosis of membranoproliferative glomerulonephritis (MPGN) was made. She received steroid therapy, immunosuppressive drug and anticoagulant therapy, and recovered sufficiently to be discharged from hospital in April, 1979. During subsequent ambulatory treatment at our outpatient department, her renal function deteriorated gradually, and maintenance hemodialysis was started from June, 1990. In July, 1991, she was admitted to our hospital with pleurisy and pericarditis. There was no improvement despite antibiotic treatments. Laboratory data revealed leukopenia and lymphopenia. Under suspicion of systemic lupus erythematosus (SLE), relevant tests were carried out. Immunological abnormalities such as positive LE cells and the presence of various autoantibodies, together with clinical signs of hypersensitivity to sunlight, stomatitis and serositis, satisfied the diagnostic criteria of the ARA and a diagnosis of SLE was made. This case did not exhibit any clinical or serological abnormalities except for the renal disorder for a 10-year period after the histological diagnosis of MPGN, but was eventually diagnosed as SLE as a result of the manifestation of SLE symptoms for the first time after one year of maintenance hemodialysis. Immunological abnormalities and SLE during maintenance hemodialysis are discussed in relation to other reports.
Shibahara
H
H
2nd Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Nagura
Y
Y
Kuno
T
T
Yanai
M
M
Kikuchi
F
F
Kinoshita
Y
Y
Takahashi
S
S
Hatano
M
M
D000328:Adult; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications* / Q000628:therapy; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D006435:Renal Dialysis