Recurrent lupus nephritis in the second allograft of a patient with systemic lupus erythematosus

Lupus glomerulonephritis is a common and serious complication of systemic lupus erythematosus (SLE) affecting up to 50% of lupus patients. Recurrent lupus nephritis is rare, complicating as low as 1% of the lupus transplant population according to some authors. However, it may be underreported with more realistic recurrent rates oscillating from 2.8 to 8.7%. We report the case of a patient with SLE who lost her first allograft 4 years after transplantation with a diagnosis of de novo fibrillary glomerulopathy. She underwent a second renal transplantation and her renal function was stable for the past 5 years. She now presented with skin rash, arthralgias and positive lupus serologies. Her creatinine was slightly elevated and proteinuria was also noted. A renal biopsy performed revealed a recurrent focal proliferative lupus nephritis (WHO III). Retrospectively, we believe that her first allograft was also lost to recurrent lupus nephritis. This is a unique case of recurrent lupus nephritis in the second allograft of a patient with SLE.     

Collapsing glomerulopathy in a girl with systemic lupus erythematosus

Collapsing glomerulopathy has increasingly been recognised in patients with conditions other than HIV. The non-HIV form of collapsing glomerulopathy generally shows little response to standard therapies. We describe a 12-year-old girl with a pre-existing diagnosis of systemic lupus erythematosus presenting with renal failure. A renal biopsy gave the histological diagnosis of collapsing glomerulopathy with evidence of “full-house” immunostaining. We propose collapsing glomerulopathy in her case, as no other cause was found was secondary to systemic lupus erythematosus. The immunophenotype of her podocytes suggested a partial de-differentiation that might have been important in her partial response to immunosuppression.     

De novo membrano-proliferative glomerulonephritis in a renal allograft

De novo glomerulonephritis (GN) in the graft is an uncommon complication of renal transplantation. We report a case ofde novo membrano-proliferative GN which occurred in a second cadaver allograft in a 42-year-old woman, who developed severe hypertension, nephrotic syndrome, and progressive renal failure. Our material and a review of the literature suggest an incidence ofde novo GN of about 0.5–2%. In contrast to most of the cases described by other authors, the membrano-proliferative type ofde novo GN in renal allografts seems to be very rare.     

De novo diabetic nephropathy with functional impairment in a renal allograft

Recurrence of diabetic nephropathy in the allograft of diabetics with end-stage renal disease who undergo renal transplantation has been reported. We report a case of a patient who underwent cadaveric renal transplantation for end-stage renal disease secondary to chronic glomerulonephritis 13 years ago. He developed steroid-induced, insulin-dependent diabetes mellitus 9 months after transplantation and florid nephrotic syndrome with progressive functional impairment due to biopsy-proven diabetic nephropathy 11 years later. This is, to our knowledge, the first report of de novo diabetic nephropathy in a renal allograft of a patient who was not a diabetic at the time of transplantation. It is suggested that histopathologic changes of diabetes mellitus cannot only recur in a renal allograft, but also can develop de novo and lead to functional impairment and ultimately affect graft survival. In view of increasing patient and graft survival in transplanted diabetic and non-diabetic patients, it is reasonable to anticipate an increased incidence of this complication.     

Longitudinal myelitis in a patient with systemic lupus erythematosus

Longitudinal myelitis is an exceedingly rare complication of systemic lupus erythematosus (SLE), of which only 11 cases have been published so far. We report a case in a 65-year-old woman in whom spinal cord dysfunction developed over several weeks, resulting in tetraparesis. She had a known history of SLE with a circulating anticoagulant. Magnetic resonance imaging of the spine and a stereotactic biopsy of a brain lesion established the diagnosis of SLE-related longitudinal myelitis. High-dose glucocorticoid therapy had started to bring about an improvement when she experienced a series of complications that were eventually fatal. Her case is unusual in that longitudinal myelitis is exceedingly rare in patients with SLE.     

Control of hyperkalemia with fludrocortisone in a patient with systemic lupus erythematosus

We describe the use of fludrocortisone in a patient with systemic lupus erythematosus, who initially presented with moderate renal insufficiency, high serum potassium, metabolic acidosis, low urine pH, and a high urinary anion gap indicating tubular dysfunction. Renal histology revealed membranous glomerulonephritis and interstitial inflammation. During the course of the disease the patient developed persistent severe hyperkalemia. Dietary potassium restriction and therapy with diuretics combined with cation exchange resins failed to decrease potassium levels sufficiently. Drug therapy including cyclosporin A, enalapril, atenolol, phenytoin, necessary to control active disease and severe hypertension contributed to elevated potassium levels. Effective correction of hyperkalemia was achieved by fludrocortisone treatment. We conclude that fludrocortisone is a potent therapeutic approach for selected patients suffering from life threatening hyperkalemia, in whom potassium elevating drugs cannot be withdrawn.     

Spontaneous Achilles tendon rupture in a patient with systemic lupus erythematosus

Spontaneous rupture of the Achilles tendon, which is associated with underlying systemic disease and concurrent oral corticosteroid therapy, is a relatively rare occurrence, with very few cases reported in the English medical literature to date. Patients with this affliction frequently present weeks to months after the rupture occurs because there is no succinct traumatic event. The neglected rupture renders surgical repair more difficult secondary to the retraction of the triceps surae muscle group and the concomitant increase in width of the defect that results. The authors present a case report of a patient with a neglected spontaneous rupture of the Achilles tendon who had been on oral corticosteroid therapy to treat the manifestations of systemic lupus erythematosus. A gastrocnemius recession was performed in a "V to Y" fashion to gain needed lengthening, and an end-to-end anastomosis was also performed. The plantaris tendon was then used to help reinforce the anastomosed site.     

系统性红斑狼疮伴双侧髌韧带断裂1例报道

系统性红斑狼疮(systemic lupus erythematosus,SLE)合并双侧髌韧带自发断裂临床上极其罕见,国际上报道50例左右[1]。对于此类少见病,临床上容易误诊,错过最佳手术时机,膝关节功能恢复不理想[2]。本文报道1例因长期服用激素并发双侧髌韧带自发断裂的SLE患者的诊治情况。