title: [Case of lupus vasculopathy associated with lupus nephritis class IV-G (A)].
abstract: Various renal vascular lesions are complicated with systemic lupus erythematosus (SLE), and are often overlooked in the actual renal biopsy specimen. We report a case of biopsy-proven lupus vasculopathy, with lupus nephritis class IV-G (A). She developed SLE at 15 years of age, and was treated with prednisolone(PSL) and cyclophosphamide (CTX). Sometimes she experienced a flare-up clinically or serologically, requiring a dose increase of oral PSL. At 40 years of age, she visited our hospital after discontinuation of hospital visits for about 4 months. Oral PSL at 30 mg per day was not effective for urinary abnormalities, increase of anti double-stranded DNA (ds-DNA) antibody titer and decrease in complement components. On admission she had hypertension (180/92 mmHg) and signs of microangiopathic hemolytic anemia. Renal biopsy findings showed the glomerular changes of lupus nephritis, WHO class IV-G (A), and lupus vasculopathy, which is marked luminal narrowing or total occlusion by abundant subendothelial accumulation of immunoglobulins and complement components. In addition to PSL, intravenous pulse CTX promptly achieved clinical remission. When lupus vasculopathy is complicated, CTX may be useful.
authors.affiliation: Department of Nephrology, Saiseikai Nakatsu Hospital, Osaka, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Eguchi
authors.forename: Keiji
authors.initials: K
authors.lastname: Shimazu
authors.forename: Kouji
authors.initials: K
authors.lastname: Takaori
authors.forename: Kensuke
authors.initials: K
authors.lastname: Nishiguchi
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.forename: Soushi
authors.initials: S
authors.lastname: Yorifuji
authors.forename: Toru
authors.initials: T
authors.lastname: Murakami
authors.forename: Masao
authors.initials: M
authors.lastname: Koshikawa
authors.forename: Atsuo
authors.initials: A
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Kuwahara
mesh_terms: D000328:Adult; D001160:Arterioles / Q000276:immunology*; D003165:Complement System Proteins / Q000378:metabolism; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000378:metabolism; D007262:Infusions, Intravenous; D007668:Kidney / Q000098:blood supply*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D011239:Prednisolone / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D016896:Treatment Outcome
chemical_list: D007136:Immunoglobulins; D003520:Cyclophosphamide; D003165:Complement System Proteins; D011239:Prednisolone