Medical Case Report

Medical Case Report

Date of Submission: February 14, 2060

Title: A Rare Presentation of Lupus Nephritis in a 28-Year-Old Patient with Rapid Renal Deterioration

Authors:

  1. Dr. Johnathan A. Smith, MD, Nephrology Department, University Hospital, New York City, USA

  2. Dr. Emily M. Chen, MD, Immunology Department, University Hospital, New York City, USA

Abstract

This case report discusses a 28-year-old woman diagnosed with lupus nephritis presenting with rapid renal function deterioration, a relatively rare manifestation in young patients. The report highlights the diagnostic process, therapeutic interventions, and the patient’s favorable response to immunosuppressive therapy. This case emphasizes the importance of timely diagnosis and a multidisciplinary approach to managing systemic lupus erythematosus (SLE) with renal involvement.

1. Introduction

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with varying manifestations, often affecting the kidneys in severe cases. Lupus nephritis remains one of the most severe organ complications, posing significant diagnostic and therapeutic challenges. Although SLE commonly presents in young adults, this case is unique due to the rapid onset of renal involvement and the patient’s atypical clinical course, which prompted intensive treatment. This report discusses the steps taken to diagnose, treat, and manage the patient’s condition in 2060.

2. Case Presentation

Patient Details

  • Age: 28 years

  • Gender: Female

  • Date of Admission: March 2, 2060

  • Presenting Symptoms: Persistent fatigue, joint pain, ankle swelling, facial puffiness, and visible hematuria

  • Medical History: Family history of autoimmune diseases (mother with rheumatoid arthritis), no prior history of kidney or autoimmune diseases

  • Social History: Works as a graphic designer, non-smoker, occasional wine consumption on weekends

  • Allergies: None

Physical Examination

  • Vital signs on admission: Blood Pressure 150/95 mmHg, Pulse 88 bpm, Respiratory Rate 16/min, Temperature 37.2°C

  • Physical findings: Swelling in both ankles, pale skin, facial puffiness, mild tenderness in joints without warmth or redness

3. Differential Diagnosis

Given the symptoms, we considered several potential diagnoses, each supported by specific signs and test results:

  1. Chronic Kidney Disease: Due to hematuria and hypertension, chronic kidney issues were initially suspected.

  2. Systemic Lupus Erythematosus (SLE): Symptoms such as joint pain, swelling, and hematuria, combined with the family history of autoimmune diseases, raised the suspicion of SLE.

  3. Glomerulonephritis: A common cause of hematuria and edema, often due to inflammation in the kidney’s glomeruli, making it a plausible consideration.

After initial tests, SLE became the primary suspected cause due to positive autoantibody results.

4. Diagnostic Assessment

A series of laboratory and imaging studies were conducted to confirm the diagnosis and assess the extent of kidney involvement.

Laboratory Tests

  • Complete Blood Count (CBC): Mild anemia with hemoglobin at 10.5 g/dL, white blood cell count at 4,000/mm³, platelet count within normal limits

  • Serum Creatinine: Elevated at 1.9 mg/dL on admission, indicating reduced kidney function

  • Blood Urea Nitrogen (BUN): Elevated at 28 mg/dL

  • Urinalysis: Presence of hematuria and significant proteinuria (3+), indicative of renal pathology

  • ANA (Anti-Nuclear Antibody) Test: Positive at a titer of 1:1280

  • Anti-dsDNA Antibody Test: Strongly positive, confirming active lupus involvement

Imaging Studies

  • Renal Ultrasound (March 5, 2060): Kidneys were slightly enlarged with increased echogenicity, suggesting inflammatory or autoimmune involvement.

Renal Biopsy (March 8, 2060): Confirmed Class III lupus nephritis (focal proliferative), guiding the treatment plan.

5. Therapeutic Intervention

Following confirmation of lupus nephritis, a treatment plan was promptly initiated to manage inflammation and protect renal function.

Initial Treatment

  • Prednisone: 60 mg daily starting March 10, 2060, to manage inflammation. The dosage was planned to taper gradually based on the response.

  • Mycophenolate Mofetil (MMF): 1,500 mg twice daily as an immunosuppressive agent to reduce kidney inflammation.

  • Hydroxychloroquine: 200 mg daily to support long-term management of SLE and prevent flares.

Adjunct Therapy

  • ACE Inhibitor (Lisinopril): 10 mg daily to manage blood pressure and provide renal protection.

  • Calcium and Vitamin D supplements: Prescribed to mitigate steroid-induced bone loss.

Patient Education
The patient was educated on medication adherence, avoiding sun exposure to reduce lupus flares, and recognizing signs of infection, given the immunosuppressive therapy.

6. Follow-Up and Outcomes

After discharge, the patient was monitored regularly to evaluate treatment efficacy and adjust medications as needed.

Follow-Up Timeline

  • March 24, 2060: Noticeable reduction in ankle swelling, creatinine stabilized at 1.5 mg/dL, no new symptoms. Prednisone was reduced to 40 mg daily.

  • April 15, 2060: Continued improvement in renal function, proteinuria reduced to trace levels. Prednisone was further tapered to 20 mg daily.

  • June 12, 2060: Patient-reported improved energy levels and no recurrence of hematuria or swelling. Prednisone was reduced to 10 mg daily.

  • December 2060: Patient stable with normal kidney function, no signs of relapse. Long-term maintenance on hydroxychloroquine and low-dose ACE inhibitor.

7. Discussion

This case underscores the challenges of treating lupus nephritis, an SLE complication. With a family history of autoimmune diseases and rapid renal involvement, quick diagnosis was vital. Early, aggressive treatment often yields positive results, as seen with this patient's response to prednisone and mycophenolate mofetil (MMF). While corticosteroids are essential, they have significant side effects, necessitating careful monitoring. This case supports MMF as an effective treatment with fewer complications than high-dose corticosteroids. By 2060, personalized immunosuppressive therapies may improve outcomes and reduce steroid dependency in SLE patients.

8. Conclusion

This case of lupus nephritis in a 28-year-old female illustrates the importance of a swift and targeted treatment approach for SLE patients with renal involvement. The patient’s response to combination therapy with steroids and mycophenolate underscores the effectiveness of this treatment modality, especially when initiated early. The outcome suggests that remission and long-term renal function stability can be achieved with ongoing monitoring and therapy adjustments. Continued research into tailored therapies may further optimize treatment for lupus nephritis in the coming decades.

References

  1. Smith JD, Greenberg ML. "Lupus Nephritis: Current Trends in Treatment." Journal of Autoimmune Diseases. 2059; 12(3): 214-226.

  2. Chen EM, Brown PL. "Long-Term Outcomes in Lupus Nephritis Patients: The Role of Mycophenolate Mofetil." Nephrology Advances. 2060; 8(2): 102-115.

  3. Nguyen L, Patel K. "Combination Therapy in Lupus Nephritis: A Comparative Study." Clinical Rheumatology. 2058; 15(1): 98-107.

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