“Lupus eritematoso sistémico complicado con nefritis”

Abstract

Systemic lupus erythematosus is a systemic autoimmune disease, its prevalence in our environment is 4 - 250 cases / 100,000, being more frequent in women who are between 15 - 45 years of age. It can affect at the same time numerous systems of the organism, but lupus nephritis is its greatest manifestation. Renal damage is caused by the deposit of intravascular immune complexes in the glomeruli, clinically we can find a silent disease, abnormal urinary sediment, a nephrotic or nephrotic syndrome with rapid progression. Renal biopsy is indicated in all circumstances in which proteinuria is evidenced. The treatment is established taking into account the age, clinical picture, systemic compromise, histological class and comorbidities. The present case describes a female patient of 18 years of age, with no significant pathological history who presented intermittent holocranial headache, pulsatile type of great intensity of 1 year of evolution, receiving analgesic treatment for several times without improvement, referred myalgia for 5 months , arthralgia and 3 months ago has asthenia with unquantified weight loss. Two weeks ago bilateral edema appeared in lower limbs with high blood pressure, received antihypertensive treatment (losartan 50mg), presented mild normochromic normocytic anemia, hematuria and proteinuria establishing a nephritic syndrome and to rule out collagen disease due to the presence of other organic compromises. Additional studies are requested in which ANA and positive DNA antibodies are evidenced. In addition C3 and C4 serum complement decreased, reaching a diagnosis of lupus erythematosus, then performed renal biopsy reporting class IV lupus nephritis initiating 1 pulse of cyclophosphamide and then mycophenolate mofetil