scholarly journals Case Report on Pregnancy with Lupus Nephritis Type IV with Hypothyroidism – A Clinical Vignette

2021 ◽  
Vol 8 (05) ◽  
pp. 272-274
Author(s):  
Abirbhab Pal
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
First Trimester ◽  
The Body ◽  
Fetal Mortality ◽  
Thyroid Disorder ◽  
Multisystem Disease ◽  
Mortality And Morbidity ◽  
Multiple Systems ◽  
Increased Risk

Lupus is a multisystem disease affecting almost all systems including the immune system of our body. Its aetiology is not known. Lupus involving kidneys causes lupus nephritis and adds more complications in the multisystem disease. Lupus or systemic lupus erythematosus (SLE) is a multifactorial chronic disease involving multiple systems of the body. It is autoimmune1 in nature. There is increase in maternal and fetal risk of mortality and morbidity in lupus with pregnancy. The rate of pregnancy loss is 1.7 %2 in active SLE during initial first trimester and the most common adverse morbidity causing factor of fetomaternal side.3 There can be an increase in fetal mortality and morbidity associated with lupus nephritis.4,5 There is increased risk of intrauterine growth restriction (IUGR) / neonatal lupus / gestational diabetes mellitus / osteoporosis / HELLP syndrome / preeclampsia. Associated thyroid disorder is increased with preterm pregnancy.

scholarly journals HLA-DRB1*04 as a Risk Allele to Systemic Lupus Erythematosus and Lupus Nephritis in the Malay Population of Malaysia

2021 ◽  
Vol 7 ◽  
Author(s):  
Malarvili Selvaraja ◽  
Voon Kin Chin ◽  
Maha Abdullah ◽  
Masita Arip ◽  
Syafinaz Amin-Nordin
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Systemic Lupus ◽  
Mortality And Morbidity ◽  
Curative Therapy ◽  
Multiple Organs ◽  
Increased Risk

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease afflicting multiple organs. Lupus nephritis (LN) is a serious complication of SLE and remains a major cause of mortality and morbidity. Curative therapy remains unavailable as etiology from genetic and environmental factors is still unclear. The present study was conducted to elucidate the link between HLA-DRB1 gene polymorphisms with SLE and LN through clinical and laboratory/biological presentations in a population of Malaysian Malay females with SLE. A total of 100 Malay female SLE patients inclusive of 70 SLE patients without LN and 30 patients with LN were included in this study. HLA-DRB1 allele examination in SLE patients was performed using PCR-SSO, and the alleles' frequencies were compared with 951 publicly available datasets representing Malay healthy controls in Malaysia. Cytokines and free radical levels were detected by ELISA and bead-based multiplexed Luminex assays. The association between HLA-DRB1 alleles with clinical and serological manifestations and immune mediators was analyzed using different statistical approaches whenever applicable. Our study showed that HLA-DRB1*0405, HLA-DRB1*1502, and HLA-DRB1*1602 were associated with the increased risk of SLE while HLA-DRB1*1201 and HLADRB1*1202 alleles were associated with a lower risk of SLE development. Furthermore, HLA-DRB1*04 showed significant association to LN and arthritis while HLA-DRB1*15 was significantly associated with oral ulcer in Malay SLE patients. Association analysis of HLA-DRB1*04 with clinical and biological factors revealed that HLA-DRB1*04 was significantly associated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, anti-nuclear antibody (ANA), C-reactive protein (CRP) in the blood, and total protein in the urine. SLE carriers with the HLA-DRB1*04 allele were significantly correlated to the increased levels of cytokines (IFN-y, GM-CSF, IL-17F, IL-18, IL-21, and VEGF) and were significantly showing negative correlation to IL-5 and free radicals (LPO and catalase enzyme) levels compared to SLE carriers without HLA-DRB1*04 allele. The results suggested that disease severity in SLE may be determined by HLA-DRB1 alleles. The risk of HLA-DRB1*04 allele with LN was supported by the demonstration of an intense inflammatory response in Malay SLE patients in Malaysia. More studies inclusive of a larger and multiple SLE cohorts in the future are warranted to validate these findings.

scholarly journals The presence of lupus nephritis additionally increases the risk of preeclampsia among pregnant women with systemic lupus erythematosus

Lupus ◽  
2021 ◽  
pp. 096120332110047
Author(s):  
Katarina Bremme ◽  
Sonja Honkanen ◽  
Iva Gunnarsson ◽  
Roza Chaireti
Keyword(s):  
Caesarean Section ◽  
Lupus Nephritis ◽  
Pregnant Women ◽  
Lupus Erythematosus ◽  
Premature Birth ◽  
Renal Involvement ◽  
Significant Risk ◽  
Obstetric Outcomes ◽  
Increased Risk ◽  
Renal Lupus

Introduction Pregnant women with systematic lupus erythematosus (SLE) have an increased risk of obstetric complications, such as preeclampsia and premature births. Previous studies have suggested that renal involvement could further increase the risk for adverse obstetric outcomes. Aims: The aim of this study was to compare the obstetric outcomes in a Swedish cohort of patients with SLE with and without lupus nephritis (LN). Patients and methods The study was conducted as a retrospective observational study on 103 women with SLE, who gave birth at the Karolinska University Hospital between the years 2000-2017. Thirty-five women had previous or active LN and 68 women had non-renal lupus. Data was collected from digital medical records. The outcomes that were analysed included infants born small for gestational age (SGA), premature birth, preeclampsia, SLE- or nephritis flare and caesarean section. Results Women with LN, both with previous and with renal flare during pregnancy suffered from pre-eclampsia more often compared to women with non-renal lupus (25.7% vs 2.9%, p = 0.001) and this complication was associated with premature birth (p = 0.021) and caesarean section (p = 0.035). Conclusions Lupus nephritis is a significant risk factor for adverse obstetric outcomes in women with SLE, including preeclampsia. Those patients could benefit from more frequent antenatal controls and more vigorous follow-up.

scholarly journals Aspirin for Prevention of Preeclampsia in Lupus Pregnancy

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Amelie M. Schramm ◽  
Megan E. B. Clowse
Keyword(s):  
Lupus Erythematosus ◽  
Low Dose ◽  
Fetal Mortality ◽  
Mortality And Morbidity ◽  
Medical Disorder ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Receive Treatment ◽  
Underlying Pathology ◽  
Active Lupus

Preeclampsia, the onset of hypertension and proteinuria during pregnancy, is a common medical disorder with high maternal and fetal mortality and morbidity. The underlying pathology remains poorly understood and includes inflammation, endothelial dysfunction, and an unbalanced thromboxane A2/prostacyclin ratio. For women with systemic lupus erythematosus (SLE), particularly those with preexisting renal disease or with active lupus, the risk of developing preeclampsia is up to 14% higher than it is among healthy individuals. The mechanism is still unknown and the data for preventing preeclampsia in lupus pregnancies are rare. Modulating the impaired thromboxane A2/prostacyclin ratio by administration of low-dose aspirin appears to be the current best option for the prevention of preeclampsia. After providing an overview of the pathogenesis of preeclampsia, preeclampsia in lupus pregnancies, and previous trials for prevention of preeclampsia with aspirin treatment, we recommend low-dose aspirin administration for all lupus patients starting prior to 16 weeks of gestation. Patients with SLE and antiphospholipid syndrome should receive treatment with heparin and low-dose aspirin during pregnancy.

scholarly journals Particulate Matter as a Driven Factor Covid19 Transmission at Outdoor: Review

2020 ◽  
Vol 12 (3) ◽  
pp. 225
Author(s):  
Hanien Firmansyah ◽  
Azmi Nur Fadlillah ◽  
Aditya Sukma Pawitra
Keyword(s):  
Particulate Matter ◽  
Physiological Condition ◽  
The Body ◽  
Mortality And Morbidity ◽  
Virus Rna ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Mucous Membranes ◽  
The Face ◽  
Droplet Transmission

Introduction: Coronavirus Disease 2019 (Covid19) is an infectious disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome-related Coronavirus) which attacks the respiratory tract, with mild to severe symptoms. The virus can infect the body through mucous membranes on the face with droplet transmission. Air pollution is thought to contribute to Covid19 events which can worsen the situation of people with Covid19. The aims of this literature review is to analyze Particulate Matter (PM) as environmental factors that contributes Covid19, so it is expected to be a study in terms of prevention and prevention in the field of environmental health. Discussion: PM is thought to have contributed to an increased risk of mortality and morbidity in Covid19 events. PM which has toxic properties can enter the lungs and affect the physiological condition of the lung organs. The findings regarding the presence of SARS-CoV-2 virus RNA strengthen the suspicion that PM plays a role in Covid19 transmission. Several studies have found that there is a relationship between PM and Covid19. PM2.5 which is smaller than PM10 has a higher ability to be a risk factor for ballast in Covid19. Conclusion: The results of this synthesis state that PM can be one of the driving factors of Covid19 transmission in air.

scholarly journals Class IV Lupus Nephritis in the Setting of Serologically Quiescent Disease and Normal Urine Sediment in a Patient with Late-Onset Systemic Lupus Erythematosus

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Benedicta Nnodum ◽  
Lauren Dudley
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
The Body ◽  
Systemic Lupus ◽  
Urine Sediment ◽  
Reactive Protein ◽  
Normal Urine ◽  
Class Iv

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that may affect any organ of the body. Lupus nephritis (LN) is a frequent and serious complication of SLE. We report a case of an 80-year-old woman who was initially diagnosed with late-onset SLE and eventually developed LN in the setting of normal complements, double-stranded DNA, C-reactive protein, erythrocyte sedimentation rate, and urine sediment. She developed abnormal renal function (creatinine of 1.7 mg/dl) and mild proteinuria (1-2+) without hematuria. Renal biopsy showed class IV lupus glomerulonephritis, active and chronic. The patient was started on mycophenolate mofetil which led to improvement of proteinuria and stabilization of creatinine. The suspicion for LN in a patient with late-onset SLE should remain high when there is development of suspicious renal or urinary abnormalities even if laboratory values do not suggest high disease activity and urinary sediment is normal. To our knowledge, this is one of the oldest patients with biopsy-proven LN and late-onset SLE.

Choroid thickness profile in patients with lupus nephritis

Lupus ◽  
2019 ◽  
Vol 28 (4) ◽  
pp. 475-482 ◽  
Author(s):  
J Braga ◽  
R Rothwell ◽  
M Oliveira ◽  
D Rodrigues ◽  
S Fonseca ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Choroidal Thickness ◽  
Central Nervous System Involvement ◽  
Enhanced Depth Imaging ◽  
Control Group ◽  
Study Group ◽  
Ophthalmological Examination ◽  
Increased Risk ◽  
Healthy Control

Background Choroidopathy is a rare manifestation of systemic lupus erythematosus (SLE). This entity is associated with active phases of severe SLE and it is frequently accompanied by acute kidney failure, central nervous system involvement and coagulopathy. Purpose To evaluate the choroid thickness of patients with lupus nephritis (LN) without choroidopathy, and to compare this with that of age-matched SLE patients without LN and healthy control subjects. Study design Cross-sectional case control study. Material and methods Fifteen women with LN in remission phase (study group), 15 women with SLE in remission without LN (SLE control group), and 15 healthy women (healthy control group), without ocular diseases or significant refractive error, were recruited. Full ophthalmological examination and a macular optical coherence tomography in enhanced depth imaging mode were performed. The choroid thickness was measured at nine macular points and six lines of mean choroidal thickness were determined. A comparative analysis between the three groups was performed using the one-way ANOVA test and the paired t-test. The choroid thickness of patients under corticotherapy was also compared to that of patients without corticotherapy. Additionally, the correlation between choroid thickness and disease duration was evaluated using the Pearson analysis. Results The mean macular choroidal thickness was 295.73 ± 67.62 μm in the study group, 233.34 ± 41.01 µm in the SLE control group, and 240.98 ± 37.93 μm in the control group ( p = 0.00006 and p = 0.0003, respectively). Additionally, the choroid thickness was significantly thicker than in the SLE and healthy control groups at the foveal ( p = 0.004 and p < 0.000), nasal ( p < 0.000 and p = 0.001), superior ( p = 0.002 and p < 0.000) and inferior ( p < 0.000 and p = 0.001) mean lines. The choroidal thickness in this group was not associated with the duration of the disease. The subgroup of patients with LN under corticotherapy did not reveal a significantly different choroidal thickness. Conclusion This study suggests a relationship between LN and choroidal changes, which may represent an increased risk for choroidopathy in these patients. Choroid thickening was not related with the duration of the disease. This thickening may be correlated with histopathological changes similar to those occurring in kidney glomeruli.

The influence of obesity on hydroxychloroquine blood levels in lupus nephritis patients

Lupus ◽  
2021 ◽  
pp. 096120332098521
Author(s):  
Tatiana Pedrosa ◽  
Léonard de Vinci Kanda Kupa ◽  
Sandra Gofinet Pasoto ◽  
Nádia Emi Aikawa ◽  
Eduardo Ferreira Borba ◽  
...  
Keyword(s):  
Body Weight ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Blood Levels ◽  
Concomitant Treatment ◽  
Obese Patients ◽  
Maximum Daily Dose ◽  
Increased Risk ◽  
Daily Dose ◽  
The Impact

Introduction In 2016 the American Academy of Ophthalmology(2016-AAO) recommended a maximum daily HCQ use of 5.0 mg/kg real body weight(RBW) taking into consideration minimizing eye toxicity. Retinopathy in systemic lupus erythematosus(SLE) patients was recently associated with obesity and this condition is progressively more common in these patients. However, the impact of obesity in HCQ blood levels remains controversial. Objective To determine if the 2016-AAO recommendation based on RBW with and without maximum daily dose restriction results in adequate and safe blood levels in obese lupus nephritis(LN) patients. Methods A cross-sectional study was performed with 108 LN patients under the prescribed 2016-AAO dose for at least 3 months. LN patients were assessed for demographic characteristics, body mass index(BMI), disease parameters, HCQ dose, concomitant treatment and HCQ blood levels measured by liquid chromatography-tandem mass spectrometry. Obesity was defined as BMI ≥30kg/m2. Results Obesity was identified in 35/108(32%) LN patients. The calculation of HCQ daily dosage revealed that obese patients were under a lower prescribed daily dose according to the real body weight (RBW) [4.4(2.9-5.4) vs. 4.9(4-5.5)mg/Kg/day, p < 0.001] due to the maximum limit used. Regardless of that the median of HCQ blood levels was significantly higher in obese compared to non-obese patients (1562 ± 548.6 vs. 1208 ± 448.9 ng/mL, p = 0.002). Further analysis of patients under the 20016-AAO recommendation by RBW without the restriction of maximum daily dose confirmed that in spite of comparable daily dose in 14 obese patients and 61 non-obese patients [4.8 (4.5-5.4) vs. 5.0(4.5-5.5) mg/kg, p = 0.312], the median of HCQ blood levels was significantly higher in obese patients than in non-obese (1734 ± 457.3 vs. 1189 ± 449.4 ng/mL, p < 0.001). Conclusion Obese patients under the 2016-AAO prescribed dose of HCQ based on RBW with and without maximum daily dose restriction have a very high HCQ blood levels compared to non-obese patients, with a potential increased risk of ocular toxicity. The use of 2016-AAO dose of HCQ according to the ideal body weight for this group of patients should be considered.Clinicaltrials.gov #NCT0312243.

scholarly journals Influence of mass and distribution of adipose tissue on the content of leptin in pregnant women at different periods gestations

2019 ◽  
Vol 16 (1) ◽  
pp. 55-61
Author(s):  
Natalya B. Chabanova ◽  
Tatiana N. Vasilkova ◽  
Valentina A. Polyakova ◽  
Sergey I. Mataev
Keyword(s):  
Body Weight ◽  
Adipose Tissue ◽  
Blood Serum ◽  
Body Mass ◽  
Fat Mass ◽  
First Trimester ◽  
Fat Deposition ◽  
The Body ◽  
Normal Body ◽  
Increased Risk

BACKGROUND: Currently, obesity is one of the most global problem in the world. Redundant accumulation of adipose tissue accompanied by metabolic disorders including high secretion of leptin may lead to an increased risk of gestational complications. AIMS: To assess the level of leptin in pregnant womens blood serum depending on their body weight and the character of content of adipose tissue in different terms of gestation. MATERIALS AND METHODS: We investigated 211 women with single pregnancies, which came in natural cycles and finished with urgent parturitions. All of them got anthropometric study, assessment of adipose tissues weight by bioimpedanceometry, character of fat deposition by ultrasound investigation of adipose tissue, determination of the level of whey leptin at 1014, 2428, 3638 weeks of pregnancy. RESULTS: Established, that the level of leptin increases in proportion to pregestational body mass index from the first trimester. Women with excess body mass and with obesity had higher concentrations of leptin all over gestation, than women with normal body mass (р0.001). The higher term of pregnancy was, the higher the level of whey leptin was in all groups, independently of character of fat deposition. In the end of third trimester, women with normal body mass had the largest value of absolute and relative increase of body mass and fatty mass, what accompanied by enlargement of the concentration of leptin more than in 3 times for the pregestational level. CONCLUSIONS: In this way, high content of leptin in pregnant womens (with excess body mass and obesity) blood serum in the first trimester is explained by redundant accumulation of the adipose tissue. The largest value of gestational increase of body mass and fat mass in group where women had normal initial weight is accompanied by the great increase of the level of leptin on the body weight unit and fat mass. These data indicate, that control and limitation of excessive weight gain while pregnancy can be a measure of prevention of the redundant leptins secretion and different gestational complications related with it.

scholarly journals Lupus Disease with Lupus Nephritis - 14 Years of Clinical-Biological Observations

2020 ◽  
Vol 17 (3) ◽  
pp. 61-69
Author(s):  
Cristina Buhoară ◽  
Nicoleta Petre ◽  
Mircea Penescu
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Nitrogen Retention ◽  
Pulse Therapy ◽  
Reduced Dose ◽  
Clinical Evolution ◽  
Azathioprine Treatment ◽  
Increased Risk ◽  
Dsdna Antibodies

AbstractWe present the case of a female patient diagnosed in 2004 with systemic lupus erythematosus, initially with joint and hematological damage complaint, for which she was treated with Methylprednisolone for 6 months. Subsequently, symptomatology and paraclinical screening raised the suspicion of renal impairment, a pulse therapy with Solumedrol and Cyclophosphamide was initiated, a total of 6 pulses. She is in the database of our Clinic since March 2008, when a renal biopsy was performed, revealing a class IV lupus nephritis, initiating treatment with Mycophenolate mofetil and Prednisone until 2010, when the dose of Prednisone is progressively reduced until cessation at the time of remission. Subsequently she presented two relapse episodes, recovered by pulse therapy with Methylprednisolone and Cyclophosphamide, followed by maintenance therapy with Mycophenolate mofetil and Prednisone with a good clinical evolution. In 2017 the patient has a pregnancy with favorable evolution (under treatment with Azathioprine), presenting normal values of cDNA, C3, C4 during the 9 months, but with a persistent nephrotic-range proteinuria; in these conditions gives birth physiologically at 37 weeks. During 2019 apparent remission is maintained (stationary nitrogen retention, anti-dsDNA antibodies within normal range), but with moderate anaemia and persistent, but diminished proteinuria (being under treatment with reduced dose Prednisolone and Mycophenolate mofetil); along the way proteinuria is accentuated again and it is decided to return to reduced dose Azathioprine treatment, with good clinical evolution.Conclusion. The presented case reinforces the idea of systematic monitoring of patients with SLE and the need for permanent adaptation of treatment especially when there is an increased risk of relapse. Pregnancy, paradoxically well tolerated, increases subsequently the risk of reactivation of lupus nephritis.

scholarly journals Nocardia asteroides Occipital Abscess as a Cause of Lupus Nephritis?

2021 ◽  
Author(s):  
Francis Essien ◽  
Joshua Tate ◽  
Wayne Latack
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Brain Abscess ◽  
Lupus Erythematosus ◽  
Immunosuppressive Treatment ◽  
Nocardia Asteroides ◽  
Systemic Lupus ◽  
Multisystem Disease

Systemic lupus erythematosus (SLE) is a multisystem disease with a complex etiology which manifests in a multitude of manners. We present a case of lupus nephritis in a patient who developed complications of immunosuppressive treatment with eventual resolution of her nephritis following cure of her Nocardia brain abscess

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