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A case complicated with SLE during maintenance hemodialysis
H Shibahara1, Y Nagura, T Kuno
12nd Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi
|April 1, 1993
Summary
A woman initially diagnosed with membranoproliferative glomerulonephritis (MPGN) later developed systemic lupus erythematosus (SLE) after a decade. This case highlights the importance of recognizing SLE in patients with end-stage renal disease undergoing hemodialysis.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- A 40-year-old woman developed nephrotic syndrome post-toxemia of pregnancy, diagnosed as membranoproliferative glomerulonephritis (MPGN) via renal biopsy.
- Initial treatment included steroids, immunosuppressants, and anticoagulants, leading to recovery and discharge.
Observation:
- Despite initial recovery, her renal function progressively declined, necessitating maintenance hemodialysis starting in June 1990.
- In July 1991, she presented with pleurisy and pericarditis, unresponsive to antibiotics, along with leukopenia and lymphopenia.
Findings:
- Diagnostic workup revealed immunological abnormalities, including positive LE cells and various autoantibodies.
- Clinical manifestations such as photosensitivity, stomatitis, and serositis met the American Rheumatism Association (ARA) criteria for systemic lupus erythematosus (SLE).
- The patient showed no SLE-related issues for 10 years post-MPGN diagnosis, with SLE symptoms emerging after one year of hemodialysis.
Implications:
- This case underscores the potential for late-onset SLE diagnosis in patients with pre-existing renal disease, particularly those on maintenance hemodialysis.
- It emphasizes the need for vigilant monitoring of immunological abnormalities and clinical signs suggestive of SLE in patients with end-stage renal disease.
- The study contributes to understanding the complex interplay between MPGN, hemodialysis, and the development of secondary SLE.