Dialysis and Pregnancy in End Stage Kidney Disease Associated with Lupus Nephritis

Female patients with systemic lupus erythematosus are often of childbearing age at diagnosis, and though fertility in these patients is similar to the general population, successful pregnancy remains a rare occurrence. This incidence is, however, increasing and the management of these high risk pregnancies is often further complicated by the patient’s need for dialysis as a result of lupus nephritis (LN). We share our experience in managing two LN patients with successful pregnancies, one on automated peritoneal dialysis and the other on haemodialysis, as well as a review of cases in the literature.

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Characteristics of lupus nephritis in Saudi lupus patients: A retrospective observational study

Lupus ◽

10.1177/0961203320947151 ◽

2020 ◽

Vol 29 (12) ◽

pp. 1638-1643

Author(s):

Majed R Albirdisi ◽

Ibrahim A Al-Homood

Keyword(s):

Saudi Arabia ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Kidney Biopsy ◽

Childbearing Age ◽

Systemic Lupus ◽

Laboratory Findings ◽

Medical City ◽

Systemic Disorder ◽

End Stage

Objectives Systemic lupus erythematosus (SLE) is a chronic autoimmune multi-systemic disorder of the connective tissue, characterized mainly by involvement of the skin, joints, kidneys, and serosal membranes. It affects females particularly at childbearing age more commonly than males. Lupus nephritis affects around half of patients with SLE. Data about SLE and lupus nephritis in Saudi Arabia are still scarce. In this study, we aimed to evaluate the prevalence, clinical and laboratory findings of SLE and different histological types of lupus nephritis among Saudi patients at King Fahad Medical City. Methods This is a retrospective study for adult patients who have been evaluated at king Fahad medical city between 2014 and 2019 and fulfilled the Systemic Lupus International Collaborating Clinics classification criteria (SLICC). Results 112 patients, 103 (92%) females and 9 (8%) males, with confirmed diagnoses of SLE were reviewed. Skin rash (69.6%), photosensitivity (61.6%), mucosal ulcerations (45.9%), arthralgia and/or arthritis (44.6%) are the most common clinical features. Ninety seven (86.6%) out of 112 patients had a recorded first visit 24 hour urine protein level, out of those only 26 (23.2) patients presented with significant proteinuria of more than 0.5grams per day. Forty four (39.2%) have undergone kidney biopsy. Class IV and III lupus nephritis are the most common reported biopsy results (43.18% and 27.28% respectively). During the study period, three patients (2.7%) developed end-stage kidney disease requiring dialysis and five (4.5%) had renal transplant. Conclusion Our study provided insight on the demographics, characteristics and presentation of SLE patients and the outcome of lupus nephritis in Saudi Arabia.

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Frequency of Histopathological patterns of Lupus Nephritis according to classification by WHO among Pakistani patients

10.53350/pjmhs211592343 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2343-2344

Author(s):

Aijaz Z. Khan Chachar ◽

Miqdad Haider ◽

Naveed A. Lashari ◽

M. Mueed Yasin ◽

Hafiz B. A. Kalhoro ◽

...

Keyword(s):

Lupus Nephritis ◽

Renal Biopsy ◽

Lupus Erythematosus ◽

Who Classification ◽

Correct Diagnosis ◽

Class Ii ◽

Class Iii ◽

Childbearing Age ◽

Systemic Lupus ◽

Cross Sectional

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder, multisystemic in nature more common in females of childbearing age. There are certain risk factors which predispose to this disease. It affects various organs, kidney is among them. Almost 60% patients having SLE ultimately leads to kidney dysfunction at some stage of the life. Aim: To find out pattern of histopathological findings of lupus nephritis as per WHO classification on kidney biopsy in Pakistan. Methodology: This cross-sectional study was completed in department of Medicine, Fatima Memorial Hospital, Lahore, from March 2016 to May, 2018. Total sample size was 165 patients. Only patients who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria were included in the study. SPSS version 25.0 was used data analysis. Results: Age of the patients was between 31-50 years i.e. 114(69.09%), mean and SD was 43.96±4.84 years, females were more commonly affected by calculating 99(59.70%). Patterns of lupus nephritis as per WHO classification and renal biopsy were noted which shows 18(10.91%) had Class I, 53(32.12%) Class II, 43(26.07%) Class III, 35(21.20%) Class IV, 10(6.06%) Class V and 6(3.64%) had Class VI. Conclusion: Class II and Class III Lupus Nephritis are the most common modalities found in patients of SLE. Every patient with Lupus Nephritis should undergo a Renal Biopsy for correct diagnosis of the class of this disease and further management accordingly. Keywords: Lupus Nephritis, SLE, renal biopsy

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Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses

Journal of Clinical Medicine ◽

10.3390/jcm11020343 ◽

2022 ◽

Vol 11 (2) ◽

pp. 343

Author(s):

Jae Il Shin ◽

Han Li ◽

Seoyeon Park ◽

Jae Won Yang ◽

Keum Hwa Lee ◽

...

Keyword(s):

Lupus Nephritis ◽

Lupus Erythematosus ◽

Calcineurin Inhibitors ◽

Infectious Complications ◽

Therapeutic Approaches ◽

End Stage Kidney Disease ◽

Comprehensive Review ◽

Meta Analyses ◽

End Stage ◽

Immunomodulatory Therapies

Background: Lupus nephritis (LN) is present in over 50% of patients with systemic lupus erythematosus (SLE) which is managed with immunosuppressive and immunomodulatory therapies. However, several novel therapeutic approaches for LN are under investigation due to the adverse effects spectrum of conventional therapy; Methods: We performed a comprehensive review of meta-analyses aggregating the comparative efficacies of various pharmacotherapies for LN. We conducted a literature search and retrieved a total of 23 meta-analyses and network meta-analyses for summarization. Pharmacotherapies were evaluated across six major outcomes: remission, relapse, mortality, end stage kidney disease (ESKD) progression, infection, and malignancy. Result: Calcineurin inhibitors (CNI), particularly tacrolimus (TAC), in combination with glucocorticoids (GC) outperformed cyclophosphamide (CPA) with GC in the rate of remission, either complete or partial remission, and in terms of infectious complications. In maintenance therapy, MMF was superior to azathioprine (AZA) as the MMF-treated patients had lower relapse rate. Interpretation: This review aggregates evidence of therapy for clinicians and sheds light on comparative efficacies of alternative LN treatments. As more promising agents are entering the market, such as voclosporin, belimumab, and obinutuzumab, LN management might undergo significant changes during the next years.

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Lupus Nephritis diagnosed by stand-alone renal histopathological findings in a middle-aged male.

JMS SKIMS ◽

10.33883/jms.v23i1.506 ◽

2020 ◽

Vol 23 (1) ◽

pp. 41-44

Author(s):

Rayees Yousuf Sheikh ◽

Nucksheeba Aziz Bhat ◽

Rajat Mangal ◽

Alok Sharma

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

High Sensitivity ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Systemic Lupus ◽

Histopathological Findings ◽

Nuclear Antigens ◽

Autoimmune Condition

Systemic lupus erythematosus (SLE) is a systemic autoimmune condition, characterized by the production of autoantibodies, predominantly against nuclear antigens. It primarily affects women of childbearing age. Men account for 4-22% of all cases in various series (1,2). Lupus nephritis can be diagnosed with high sensitivity and specificity based on histopathological criteria alone (3). We report lupus nephritis in a 50-year-old male diagnosed solely on renal histopathological findings.

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Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1476 ◽

2017 ◽

Vol 9 (2) ◽

pp. 134-136

Author(s):

Leelavathi Basava ◽

K Triveni ◽

G Sindhu Sree

Keyword(s):

Systemic Lupus Erythematosus ◽

Pregnancy Outcome ◽

Lupus Erythematosus ◽

Immunosuppressive Agents ◽

Fetal Loss ◽

Therapeutic Interventions ◽

Elective Cesarean Section ◽

Childbearing Age ◽

Systemic Lupus ◽

Successful Pregnancy

ABSTRACT Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of childbearing age and may coexist with pregnancy. Disease exacerbation, increased fetal loss, neonatal lupus, and an increased incidence of preeclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids, and immunosuppressive agents pose a high risk for both the mother and the fetus during the antenatal period as well as postpartum. Good multidisciplinary medical care is mandatory when detection or flare-up of SLE occurs during pregnancy. We describe the successful management of an antinuclear antibody, antiribonucleoprotein antibody, and anti-Sjogren's syndrome A (Ro) antibody positive parturient with bad obstetric history who underwent elective cesarean section and delivered a healthy child. How to cite this article Basava L, Roy P, Triveni K, Sree GS. Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus. J South Asian Feder Obst Gynae 2017;9(2): 128-130.

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Systemic lupus erythematosus, lupus nephritis and end-stage renal disease: a pragmatic review mapping disease severity and progression

Lupus ◽

10.1177/0961203320932219 ◽

2020 ◽

Vol 29 (9) ◽

pp. 1011-1020

Author(s):

Anadi Mahajan ◽

Justyna Amelio ◽

Kerry Gairy ◽

Gavneet Kaur ◽

Roger A Levy ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Renal Disease ◽

Lupus Erythematosus ◽

End Stage Renal Disease ◽

Elevated Serum ◽

Systemic Lupus ◽

Histological Transformation ◽

Stage Renal Disease ◽

End Stage

Objective The understanding of systemic lupus erythematosus (SLE) and lupus nephritis (LN) pathogenesis remains incomplete. This review assessed LN development in SLE, within-LN progression and progression to end-stage renal disease (ESRD). Methods A keyword-based literature search was conducted, and 26 publications were included. Results Overall, 7–31% of patients had LN at SLE diagnosis; 31–48% developed LN after SLE diagnosis, most within 5 years. Class IV was the most commonly found LN class and had the worst prognosis. Histological transformation occurred in 40–76% of patients, more frequently from non-proliferative rather than proliferative lesions. Cumulative 5- and 10-year ESRD incidences in patients with SLE were 3% and 4%, respectively, and 3–11% and 6–19%, respectively, in patients with SLE and LN. Conclusions Elevated serum creatinine was identified as a predictor of worsening disease state, and progression within LN classes and from SLE/LN to ESRD. This review highlights the substantial risk for developing LN and progressing to ESRD amongst patients with SLE.

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Lupus Nephritis; Pathogenesis and Treatment Update Review

Open Science Journal ◽

10.23954/osj.v6i1.2811 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Elmukhtar Habas ◽

Fahim Yousaf Khan

Keyword(s):

Lupus Nephritis ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Systemic Lupus ◽

Different Types ◽

Histopathological Studies ◽

End Stage ◽

Symptoms And Signs ◽

Histopathological Lesion ◽

Rule Out

Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE). LN is a leading cause of morbidity and mortality in SLE patients. LN presents with various symptoms and signs, ranging from asymptomatic renal involvement to End-Stage Renal Failure (ESRD). The pathogenesis of LN is not clearly understood, however, there are extra and intra-renal underlying factors that have been postulated in LN pathogenesis. Renal biopsy is crucial to stage LN and to rule out other causes. Histopathological studies have shown six different types of LN. Knowing the histopathological lesion, chronicity and the disease activity are essential to plan the LN treatment and to predict the outcome. There are different regimens for treating LN. In this review, LN pathogenesis and new advances in treatment will be briefly reviewed.

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Successful pregnancy outcome in grade IV lupus nephritis and secondary antiphospholipid antibody syndrome with recurrent pregnancy failures - challenging achievement of motherhood

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20164689 ◽

2016 ◽

Vol 6 (1) ◽

pp. 329

Author(s):

Kaliki Hymavathi Reddy ◽

Kolla Praveen Kumar ◽

Surekha Tadisetti ◽

Divya Pusarla

Keyword(s):

Lupus Nephritis ◽

Lupus Erythematosus ◽

Interesting Case ◽

Medical Community ◽

Medical Illness ◽

Antiphospholipid Antibody ◽

Antiphospholipid Antibody Syndrome ◽

Childbearing Age ◽

Successful Pregnancy ◽

Pregnancy And Delivery

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high viz., increased risks of preterm birth, hypertensive diseases of pregnancy and lupus flares both during pregnancy and in the postpartum period. An additional association with Antiphospholipid antibody (APLA) syndrome is expected to multiply the pregnancy complications. Though improved understanding of the disease nature and greater number of therapeutic options in the treatment of SLE, made the medical community regard these patients with less trepidation, the risk of significant morbidity to both the mother and the fetus still exist. We report an interesting case of grade IV Lupus nephritis (LN) with secondary APLA syndrome and h/o recurrent pregnancy failures for twenty times but had a successful pregnancy and delivery in the 21st attempt though pregnancy was absolutely contraindicated in view of her medical illness. Many complications were encountered during her pregnancy which could be successfully tackled and a live male baby was delivered by Caesarean section.

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EP16 Challenges in treating new onset systemic lupus erythematosus with lupus nephritis and COVID-19 infection overlap

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa052.015 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Selma Dahou ◽

Tim Leach ◽

Kathryn Bostock ◽

Jonathan Louden ◽

Jonathan Raj ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Lupus Nephritis ◽

Immunosuppressive Therapy ◽

Lupus Erythematosus ◽

Childbearing Age ◽

Systemic Lupus ◽

Suitable Alternative ◽

Increased Risk ◽

History Of

Abstract Case report - Introduction COVID-19 infection caused by a novel coronavirus SARS-coV-2 has made the diagnosis and the treatment of inflammatory diseases incredibly challenging. On the one hand, because of its pro-inflammatory state, that may aggravate or trigger flares in autoimmune diseases such as systemic lupus erythematosus (SLE). On the other hand, the risk of an immunosuppressive therapy during the active phase SARS-coV-2 infection that may lead to catastrophic outcomes. We report a case of a 24-year-old female newly diagnosed with SLE during COVID-19 pandemic who developed COVID-19 infection during her induction treatment for lupus nephritis. Case report - Case description A 24-year-old Nepali female, with no past medical history of note, presented to her regional hospital with a history of flu-like symptoms few days ago, peripheral oedema, acute kidney injury with proteinuria and hypertension. Further investigations showed a high titre of double-stranded DNA antibodies, anti-cardiolipin IgM and B2 microglobulin positive and low C3. She also developed a haemolytic anaemia and thrombocytopenia during her admission. She received pulsed steroid therapy and was started on mycophenolate mofetil (MMF) for a probable lupus nephritis awaiting the results of biopsy, which showed later a lupus nephritis Class IV-G with active lesions. She then developed symptoms of COVID-19 infection and had a positive PCR leading to an interruption of her induction therapy. She was recruited to the RECOVERY trial on the lopinavir-ritonavir arm and made a good recovery. Case report - Discussion It is well known that viruses can trigger or aggravate auto-immune response in patients predisposed genetically. However, the role of SARS-coV-2 is not elucidated yet. The EULAR COVID-19 registry showed that rheumatoid arthritis and SLE were the most prevalent rheumatic diseases, and there was an increased risk in those who are on moderate to high dose corticosteroids. In patients with SLE and COVID-19 infection, it is agreed by all the national and international rheumatology societies to interrupt their immunosuppressive therapy until the symptoms resolve, especially those with renal involvement or an active disease. Which is the case in our patient. Luckily, she resumed her MMF a month later after a negative PCR and her renal function has continued to improve. Case report - Key learning points Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE. It requires an early immunosuppressive treatment to induce remission. Randomized clinical trials showed that MMF is at least equally effective as cyclophosphamide in inducing remission and that it has been associated with a reduced risk of infection and amenorrhea. It seems to be a suitable alternative in women of childbearing age. In patients with concomitant COVID-19 disease, immunosuppressive therapy should be paused until the symptoms improve.

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