Lupus Nephritis Compound With Lupus Pneumonia:a Case Report And Review Of The Literature

OBJECTIVE:Discuss with the manifestation and treatment of secondary nephrosyndrome resulted from lupus nephritis and to explore characteristics Of lupus pneumonitis.METHOD:To retrospectively analyze a clinical record about a patient with secondary nephrotic syndrome results from lupus nephritis who also suffers from lupus pneumonitis and to review the literature.DESIGN:Case report.PATIENT:The patients who occured with edema and purpura3years ago, has visited many hospitals,and was diagnosed as thrombocytopenic purpura/Chronic nephritis syndrome, received regular hormone therapy, but1month ago still repeated edema and purpura. along with heart palpitations,stamochache and fatigue.INTERVENTION:After admitted to hospital, in order to rule out the autoimmune disease,detected the autoantibodies and found anti-Sm and anti-nRNP are positive,in view of the other clinical symptoms,diagnosed of systemic lupus erythematosus. According to the SLEDAI score received methylprednisolone combined cyclophosphamide therapy.As to damage of the blood system,we gave positive supplementary of platelets and hematopoietic raw material,along with stimulating hematopoiesis to rectify anemia and corrected disturbances of blood coagulation,meanwhile we also did bone marrow puncture.For edema,gave diuretic dehydration and continuous blood purification therapy, and then did renal biopsy,the patient also recieved nutrition treatment.RESULT:Renal biopsy pathology confirmed as lupus nephritis (III(A/C)+V),the patient also has renal failure,giving the immunosuppression and nutritional treatment,however the patient fevered repeatedly,the chest suggested compounding lupus pneumonia,while bacterial infection is still possible,after increased the oxygen concentration and strengthened the antibiotic treatment,the patient still had progressive lower blood oxygen saturation,and finally progress to type I respiratory failure,according to opinions of relevant departments,there is risk of adult respiratory distress syndrome,the patient is in a critical condition,after consulting by kinship,the patient finally left the hospital.CONCLUSION:Systemic lupus erythematosus (SLE) is an autoimmune disease,especially happens in women of reproductive years, can appear different systemic damage,such asskin,joints,blood system and lung,kidney,braincan be infected.But when women of reproductive years appear as damage of blood system and kidney,we should detect autoantibodies at first,to exclude systemic lupus erythematosus (SLE),to avoid missed diagnosis and misdiagnosis.About100%of patients with systemic lupus erythematosus has kidney pathological changes in histology,lupus nephritis which’s pathogenesis and clinical manifestations has diversity treatment for it should depend on the renal pathology.When the patient appeared with platelet reduction and anemia, we should cure it meanwhile identify with other diseases.When the patient appeared with intractable edema,conventional treatment has poor effect,blood purification should be accepted to do the renal biopsy in time,in order not to delay the following treatment.Patients with systemic lupus erythematosus (SLE) appeared lung damage has the certain difficulty to tell with bacterial lung infections,attention should be paid to them.