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.
Wu
Chien-Te
CT
Department of Pediatrics, Division of Immunology and Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan.
Fu
Lin-Shien
LS
Wen
Mei-Chin
MC
Hung
Shein-Chung
SC
Chi
Ching-Shiang
CS
D058186:Acute Kidney Injury / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D008181:Lupus Nephritis / Q000150:complications / Q000473:pathology* / Q000628:therapy; D010956:Plasmapheresis; D014652:Vascular Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight