[Management of lupus nephritis in Senegal].
Systemic lupus erythematosus is a disease considered as seldom in Senegal. Nevertheless its incidence is increasing these last years. The prognosis is significantly related to the renal involvement, classified into 6 classes by the WHO. The treatment of these different forms is variable, consisting on abstention or symptomatic treatment for the class III (with low activity index), class II, I, and V (without renal failure). In the other hand a vigorous treatment is indicated in the class III, with consistent activity index, class IV and class V with renal failure. The most frequent of these treatment remains the association using corticosteroids and immunosuppressants. Among immunosuppressants, cyclophosphamide and azathioprine are the most commonly used. The case we reported is about a 41 years old woman who presented a class IV lupic nephropathy, with a good outcome after a 18 months corticosteroid and immunosuppressants association treatment. This case leads us to some recommendations. Considering our poor socioeconomical conditions, we suggest to treat all patients presenting proteinuria higher than 2 mg/24h. However it is more judicious to perform renal biopsy on patients with signs evocating renal impairement and to treat the class III, IV and V whatever would be the degree of activity and chronicity indexes. This treatment must associate immunosuppressive drugs and corticosteroids; the modalities and duration depending on clinical presentation, histologic features and evolution.
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Travail de la Clinique Médicale I-CHU A. Le Dantec.
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Pouye
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Diop
T M
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D000568:Amenorrhea / Q000139:chemically induced; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy*; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D011507:Proteinuria / Q000209:etiology; D012675:Senegal
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011241:Prednisone; D008775:Methylprednisolone
Réflexions sur la prise en charge de la néphropathie lupique au Sénégal.