“Monitoring Systemic Lupus Erythematosus” Andres Quiceno, MD Presbyterian Hospital of Dallas

Medellin, Colombia

“Monitoring Systemic Lupus Erythematosus” 58 y/o white female diagnosed with SLE on 2003 when presented with +ANA, arthritis, skin rash, proteinuria and dsDNA antibodies. On November 2003 she underwent a renal biopsy that was reported as Lupus Nephritis with Focal Segmental Proliferative/Sclerosis (WHO Class III) with very mild activity. Patient was evaluated on 2/04, she was asymptomatic and her disease was consider quiescent. 24 hrs urine at that time revealed CrCl 57 ml/min and 130 mg of protein.

“Monitoring Systemic Lupus Erythematosus” On 4/04 patient went to her scheduled appointment and reported that she was doing very well, her only complaint was dry cough that she thought was secondary to dust, (her house had been remodeled) and she noticed some foamy urine. 24 hr urine was repeated and revealed a CrCl of 26 ml/min and 2064 mg of protein, and her serum creatinine was 2.3 mg/dl. Complement were within normal limits and dsDNA was 33. Patient started treatment empirically with prednisone 40 mg PO QD and CellCept 1 g PO BID and nephrology was consulted.

“Monitoring Systemic Lupus Erythematosus” Pulmonary function tests were done and revealed a normal spirometry but a decreased in the DLCO (12.35 ml/min/mmHg) 55% of the predicted. High resolution CT scan of the chest revealed “Irregular regions of parenchymal change, probable scarring from a prior infectious or inflammatory process”. 2 nd renal biopsy done on April/2004 revealed a Diffuse Proliferative Glomerulonephritis with Crescent Formation consistent with Class IV Lupus Nephritis (WHO). Patient started on treatment with cyclophosphamide IV.

“Monitoring Systemic Lupus Erythematosus” Lupus Nephritis increase morbidity and mortality in SLE. Patients with Proliferative Glomerulonephritis usually progress to end stage renal disease if they don’t receive immunosuppressive therapy. The standard treatment is based in the classic trials from NIH done in the 70s. But this trials only followed patients up to 2 years. The best regimen to keep remission has not been establish.

Chan, T. M. et al. N Engl J Med 2000;343: Characteristics of 42 Patients with Diffuse Proliferative Lupus Nephritis, According to the Assigned Treatment

Chan, T. M. et al. N Engl J Med 2000;343: Mean ({ /-}SD) Serum Albumin Concentration and Urinary Protein Excretion in Patients with Diffuse Proliferative Lupus Nephritis Who Were Treated with Mycophenolate Mofetil and Prednisolone (Group 1) or with Cyclophosphamide and Prednisolone Followed by Azathioprine and Prednisolone (Group 2)

Chan, T. M. et al. N Engl J Med 2000;343: Mean ({ /-}SD) Serum C3 and Creatinine Concentrations in Patients with Diffuse Proliferative Lupus Nephritis Who Were Treated with Mycophenolate Mofetil and Prednisolone (Group 1) or with Cyclophosphamide and Prednisolone Followed by Azathioprine and Prednisolone (Group 2)

Chan, T. M. et al. N Engl J Med 2000;343: Laboratory Values at Base Line and at 12 Months, According to the Assigned Treatment

Chan, T. M. et al. N Engl J Med 2000;343: Outcome of Treatment

Chan, T. M. et al. N Engl J Med 2000;343: Adverse Effects

Contreras, G. et al. N Engl J Med 2004;350: Characteristics of the Patients at the Beginning of Induction and Maintenance Therapy

Contreras, G. et al. N Engl J Med 2004;350: Rates of Amenorrhea, Infections, and Other Adverse Events during Maintenance Therapy

Contreras, G. et al. N Engl J Med 2004;350: Kaplan-Meier Estimates of Patient Survival

Contreras, G. et al. N Engl J Med 2004;350: Kaplan-Meier Estimates of Event-free Survival

Contreras, G. et al. N Engl J Med 2004;350: Kaplan-Meier Estimates of Relapse-free Survival

Monument to the “Race” Medellin, Colombia “Nutibara Hill”