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Management of Mixed Lupus Nephritis in a Young Female with SLE

This case study follows a 20-year-old female with SLE presenting persistent active urinary sediment, detailing her treatment, symptom resolution, hospitalization, and ongoing challenges.

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Management of Mixed Lupus Nephritis in a Young Female with SLE

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  1. U06-4031 # 535572610 20 years old female. SLE  2 yrs. Persistently active urinary sediment. Creat 61.

  2. 20 yo Native female with SLE -2004: malar rash, fatigue, wt loss, alopecia, arthralgias x 8 months -Rheum: ANA+, dsDNA –ve, anti-Smith +ve, low C3/C4, sCr 52, bland u/a  Tx: Plaquenil, Prednisone 10 -Sx resolved, April, 2005: tapered Pred to 5 mg -Sept, 2005: Hospitalized: fever, Htn, u/a: >50 RBC, proteinuria ~2g/d, sCr 69 -Tx with ?Abx “pyelo” sx resolved -Dec, 2005 (Nephro): Arthralgias, mild anorexia. N BP, slight malar rash sCr 62, sAlbumin 25, Hb 112 NCNC, C3/C4 N u/a: no spot proteinuria, 6-10 RBC -March 1, 2005: Difficulty follow-up Ongoing hematuria (>50 RBC/HPF), recurrent proteinuria (~1g/d)  biopsy

  3. IF • IgG-strong coarsely granular capillary loop staining • IgA- mild to moderate coarsely granular capillary loop staining • IgM- negative • C3- moderate coarsely granular capillary loop staining • C1q-negative • Kappa- moderate coarsely granular capillary loop staining • Lambda- NA • Fibrin- negative • Albumin- moderate hyaline droplet changes in tubular cytoplasm

  4. IgG

  5. IgA

  6. C3

  7. Kappa

  8. Albumin

  9. Diagnosis:Renal Biopsy:Mixed Membranous and Focal Proliferative lupus nephritis, of low activity and no chronicity

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