Silent Storm: The Unfolding of Lupus Nephritis in a Young Female Patient


Authors : Dr. Ishana Gaur

Volume/Issue : Volume 9 - 2024, Issue 9 - September


Google Scholar : https://tinyurl.com/mr3jvpen

Scribd : https://tinyurl.com/2yy9cur6

DOI : https://doi.org/10.38124/ijisrt/IJISRT24SEP1227

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.


Abstract : Background Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with multi-organ involvement, particularly affecting the kidneys in the form of lupus nephritis. Lupus nephritis is a severe complication of SLE and is a leading cause of morbidity and mortality in these patients. The disease primarily affects young adults and is characterized by proteinuria, hematuria, and kidney dysfunction. Early diagnosis and timely treatment are crucial in preventing progression to end-stage renal disease.  Case Report A 32-year-old female presented with a three-month history of skin rashes, hair loss, oral ulcers, and joint pain, followed by the development of edema, generalized weakness, and frothy urine. Physical examination revealed significant pitting edema, ascites, and pleural effusion. Laboratory investigations showed anemia, hypoalbuminemia, hypercholesterolemia, elevated inflammatory markers, and proteinuria in the nephrotic range. Autoimmune markers were positive for ANA, dsDNA, and other lupus-associated antibodies. Renal ultrasound revealed increased cortical echogenicity, and a kidney biopsy confirmed membranous lupus nephritis (ISN/RPS Class V). The patient was started on high-dose corticosteroids and cyclophosphamide for induction therapy, followed by a maintenance regimen. Her condition improved significantly, with proteinuria reduced to less than 0.5 grams/24 hours, and her edema resolved.  Conclusion This case emphasizes the importance of early recognition and treatment of lupus nephritis in patients with SLE to prevent irreversible kidney damage. The patient's favorable response to timely immunosuppressive therapy highlights the critical role of aggressive treatment in controlling disease activity and improving outcomes. Regular follow-up and monitoring are essential to ensure long-term disease control and prevent relapses.

Keywords : Systemic Lupus Erythematosus (SLE) , Lupus nephritis, Membranous nephropathy, Renal biopsy, Nephrotic syndrome, ANA positivity, dsDNA antibodies, ISN/RPS classification

References :

  1. Tselios, K., & Gladman, D. D. (2021). Systemic lupus erythematosus: An overview of clinical manifestations. Journal of Autoimmunity, 116, 102568.
  2. Doria, A., & Ghirardello, A. (2019). Lupus nephritis: Pathogenesis and treatment. Nature Reviews Nephrology, 15(1), 61-73.
  3. Drenkard, C., & Alarcón-Segovia, D. (2017). Lupus nephritis: An update. Clinical Rheumatology, 36(3), 477-490.
  4. Gatto, M., & Tincani, A. (2020). Update on lupus nephritis. Nature Reviews Nephrology, 16(1), 10-22.
  5. Houssiau, F. A., & D'Cruz, D. P. (2018). Lupus nephritis: Pathophysiology, clinical presentation, and management. Nature Reviews Nephrology, 14(10), 635-652.
  6. Appel, G. B., & Waldman, M. (2018). The importance of early diagnosis and treatment of lupus nephritis. American Journal of Kidney Diseases, 72(5), 718-724.
  7. Bertsias, G., & Ioannidis, J. P. (2018). EULAR recommendations for the management of systemic lupus erythematosus. Annals of the Rheumatic Diseases, 77(3), 394-405.
  8. Chan, T. M., & Tang, S. C. (2021). Treatment of lupus nephritis: A critical review. Clinical Journal of the American Society of Nephrology, 16(5), 709-719.
  9. Gharavi, A. E., & Khamashta, M. A. (2020). The role of autoantibodies in the diagnosis and management of lupus nephritis. Journal of Autoimmunity, 110, 102429.
  10. Fok, M. J., & Liu, X. (2021). Lupus nephritis: A review of the current management strategies. Current Opinion in Rheumatology, 33(6), 580-587.

Background Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with multi-organ involvement, particularly affecting the kidneys in the form of lupus nephritis. Lupus nephritis is a severe complication of SLE and is a leading cause of morbidity and mortality in these patients. The disease primarily affects young adults and is characterized by proteinuria, hematuria, and kidney dysfunction. Early diagnosis and timely treatment are crucial in preventing progression to end-stage renal disease.  Case Report A 32-year-old female presented with a three-month history of skin rashes, hair loss, oral ulcers, and joint pain, followed by the development of edema, generalized weakness, and frothy urine. Physical examination revealed significant pitting edema, ascites, and pleural effusion. Laboratory investigations showed anemia, hypoalbuminemia, hypercholesterolemia, elevated inflammatory markers, and proteinuria in the nephrotic range. Autoimmune markers were positive for ANA, dsDNA, and other lupus-associated antibodies. Renal ultrasound revealed increased cortical echogenicity, and a kidney biopsy confirmed membranous lupus nephritis (ISN/RPS Class V). The patient was started on high-dose corticosteroids and cyclophosphamide for induction therapy, followed by a maintenance regimen. Her condition improved significantly, with proteinuria reduced to less than 0.5 grams/24 hours, and her edema resolved.  Conclusion This case emphasizes the importance of early recognition and treatment of lupus nephritis in patients with SLE to prevent irreversible kidney damage. The patient's favorable response to timely immunosuppressive therapy highlights the critical role of aggressive treatment in controlling disease activity and improving outcomes. Regular follow-up and monitoring are essential to ensure long-term disease control and prevent relapses.

Keywords : Systemic Lupus Erythematosus (SLE) , Lupus nephritis, Membranous nephropathy, Renal biopsy, Nephrotic syndrome, ANA positivity, dsDNA antibodies, ISN/RPS classification

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe