Lupus nephritis

August 03, 2019

Lupus nephritis

31yrs old female patient

Came with

H/o ingestion of herbal medicine 1 tab 6months back (black magic ?),After which she was normal for 2 months then she developed headache and generalised bodypains,hairloss for which she took multiple consultantions and got treatment for 4 months but not relieved

She used treatment advised by a local doctor for 3 days then she developed high grade fever and rash over face,UL,LL, that lasted for 1 to 1 1/2 month, she was admitted for 2 days in hospital but symptoms not subsided then she went to local RMP and got treated

Then she developed facial puffiness for which she went to doctor where she was having high BP recording and was started on antihypertensive then she developed decreased urine output and legs swelling ,loss of appetite since 1 month

H/o loose stools since 10 days, severe multiple joint pains

then she came to our hospital here for further management

Non diabetic,non Hypertensive

O/E

Facial puffiness+

Generalised edema+ grade 4

PR-84/min,

Bp-150/100mmhg

Digital healed infarcts over fingers was noticed

Non scarring alopecia ?

Provisional diagnosis -

Nephrotic syndrome

SLE ? With renal involvement .

We evaluated the cause of generalised edema

,CBP showed - normocytic hypochromic anemia, leucopenia and thrombocytopenia

2D echo was normal

CUE- showed albuminuria

24hrs urine protein was not in nephrotic range,she was oliguric with raised creatinine of 2.0

As we suspected lupus nephritis in view of hemotological criteria,joint pains,digital infarcts,with alopecia ,psychiatrist opined to be having psychosis & paranoid like features

ANA profile was sent and it came to be positive- (speckeled pattern was seen )