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Author Topic: How would you treat this SLE patient?
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Posts: 18
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Post How would you treat this SLE patient?
on: June 8, 2011, 12:20
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The history:
A 34 year old Caucasian male with lupus nephritis since 1996. At that time, he was treated with CYC (induction) and placed on MPA for maintenance. At the time of the biopsy, he had the following labs:

  • serum Cr 1.2
  • proteinuria of 1.2 grams
  • low complement levels
  • (biopsy results are not available

He self discontinued MPA 7 years ago and was lost to medical follow-up.

Now, he is admitted for a lower extremity DVT. His new labs show:

  • serum Cr 4.2
  • proteinuria of 4.8 grams
  • moderately low complement levels

The biopsy findings are:

  • biopsy showing class IV-S based on ISN/RPS classification system
  • severe tubular atrophy and interstitial fibrosis
  • 3 of 11 glomeruli globally sclerosed

What would you do next?

Thanks.
Tejas
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Posts: 23
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Post Re: How would you treat this SLE patient?
on: January 17, 2013, 14:30
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Unfortunately there is a good chance that this patient will require renal replacement therapy in the near future, and that treatment (re-induction with CYC, for example) would not alter his course. I take this position primarily based on the renal biopsy results, that show a sclerosing class 4 histologic pattern along with severe IF/TA.

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