A clinical study of 5 patients with lupus nephritis who underwent dialysis for acute renal failure and successfully discontinued dialysis

We studied 5 patients with lupus nephritis who underwent dialysis for acute renal failure (ARF) and successfully discontinued dialysis to examine their clinicopathological features and elucidate some therapeutic problems. The patients with lupus nephritis leading to ARF showed nephrotic syndrome and hematuria of more than a moderate degree. Histological study revealed 4 DPLNs and a mesangial LN. Three of four patients with DPLN showed interstitial fibrosis of a moderate degree, indicating the presence of considerable number of destroyed nephrons. Renal function in the four patients with DPLN deteriorated and varied from 14ml/min to 42ml/min CCr on discontinuation of dialysis. A patient with mesangial LN revealed mild interstitial fibrosis and recovered normal renal function with CCr of 90ml/min. The period for which dialysis was required varied from one month to 4 months (averaging 2 months). For the treatment of lupus nephritis, high dose corticosteroid was used with or without combined immunosuppressants. All patients received one to three courses of methylpredonisolone pulse therapy as well. In three patients for whom the pulse therapy was done before the onset of ARF, progression to ARF was not interrupted with this therapy. During the treatment of these five patients with lupus nephritis, sixteen complications were observed, eleven of which were infectious diseases (6 viral infections, 2 fungal infections, one nocardiosis, and 2 tuberculosis). Opportunistic infections and tuberculosis were seen on numerous occasions. In case 3, renal vein thrombosis due to a femoral catheter used for hemodialysis was considered to have aggravated nephrotic syndrome. Because potent immunosuppressive therapy against lupus nephritis has to be given even under the immunocompromised condition of ARF, fatal infections almost inevitably occur in patients with lupus nephritis leading to ARF. Therefore, it is important to make an early diagnosis of the fatal infections if they occur and to initiate appropriate intensive treatment as quickly as possible in order to save these patients.