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

We 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.