Follow Us:

social twitter box white 32 social facebook box blue 32social linkedin box blue 32ISN Blog

ISN Education: Ask the Experts

  1. fatma-abbas
  2. Glomerular Diseases
  3. Saturday, February 04 2017, 10:15 PM
  4.  Subscribe via email

We would like to know your thoughts about the etiology of this patient’s hemoptysis and about our management of this patient thus far. The patient is an 18-year-old female who was diagnosed with lupus nephritis at the age of 16 (without a renal biopsy). She has been maintained at various times with solupred, cellcept, and/or hydroxychloroquine. Seven months after her initial diagnosis she developed lupus pneumonitis and required pulse-dose steroids. After approximately 9 months of therapy with one of the above medications, a renal biopsy was performed: class 4 lupus nephritis. At the time of the biopsy, she was placed on pulse –dose steroids again but developed convulsions. A brain MRI was consistent with lupus cerebritis. She was treated with a course of high-dose steroids, endoxan, ACE inhibitor, and other blood pressure medications. At this time, her serum creatinine ranged from 4.4 mg/dl to 5.1 mg/dl (BUN 43 to 54). Approximately one week later she presented with frank hemoptysis and hypertension (170/110 mm Hg). A chest CT scan revealed bilateral lung infiltrates (R > L). Labs revealed a hemoglobin of 6.5 g/dl, creatinine of 7.0 mg/dl, and platelet count 90,000. Hemodialysis along with additional pulse-dose steroids was administered. She remains dependent on renal replacement therapy and both steroids and endoxan.

Comment
There are no comments made yet.
Add Comment
Tejas Desai Accepted Answer
0
Votes
Undo

Greetings Fatma,

We sent your question out to our social media community of nephrologists. Seems many folks not enthusiastic about using #cyclophosphamide. Here's the Facebook poll results:https://www.facebook.com/isnkidney/posts/1225383554215096

When the same question was concurrently asked on Twitter, the nephrology community overwhelmingly chose answer choice #3 (https://twitter.com/isnkidneycare/status/828923283420635136). However a ? % of those who chose "Other" recommended using Cyclophosphamide.

Best, Tejas Desai (ISN Online Editorial Coordinator)

Comment
Mostly this pat has lung hemorrhage secondary to Lupus pneumonia but other deformation most be in mind DIC secondary to induction so we mast know pt and ptt blood film if pt and ptt normal I well consedar plazmophresis
  1. Guest
  2. 1 month ago
There are no comments made yet.
Add Comment
  1. more than a month ago
  2. Glomerular Diseases
  3. # 1
Martin Bitzan Accepted Answer
0
Votes
Undo

Greetings Fatma,

This is a complicated case.

I am not sure if the hemoptysis is still a problem and if it was due pneumonia and vessel arrosion or other problems.

Has a bronchoscopy with BAL been performed ?

Does the patient happen to have ANCAor anti-GBM antibodies ?

Is the hypertension due to lupus or is insufficient fluid removal a contributing factor ?

Best wishes,
Martin Bitzan

Comment
There are no comments made yet.
Add Comment
  1. more than a month ago
  2. Glomerular Diseases
  3. # 2
  • Page :
  • 1


There are no replies made for this post yet.
However, you are not allowed to reply to this post.

Global Operations Center

Rue des Fabriques 1
1000 Brussels, Belgium
Tel: +32 2 808 04 20
Fax: +32 2 808 4454
Email contact

               

Americas Operations Center

340 North Avenue 3rd Floor
Cranford, NJ 07016-2496, United States
Tel: +1 567 248 9703
Fax: +1 908 272 7101
Email contact