Haemolytic-uraemic syndrome during severe lupus nephritis: efficacy of plasma exchange

Intern Med J. 2012 Jan;42(1):95-8. doi: 10.1111/j.1445-5994.2011.02591.x.

Abstract

Systemic lupus erythematosus (SLE) has been described as a cause of thrombotic microangiopathy, especially thrombotic thrombocytopenic purpura (TTP). Haemolytic-uraemic syndrome (HUS) is less frequent in SLE. We report a case of such an association during an episode of severe lupus nephritis in a young woman, who was successfully treated with steroids, cyclophosphamide and especially plasma exchange with plasma replacement. This report highlights the importance of recognising atypical HUS in SLE patients by looking for schistocytes in case of haemolytic anemia with a negative antiglobulin test, in order to begin plasma exchange.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Acute Kidney Injury / etiology
  • Adult
  • Biopsy
  • Combined Modality Therapy
  • Cyclophosphamide / therapeutic use
  • Drug Therapy, Combination
  • Erythrocytes, Abnormal
  • Female
  • Hemolytic-Uremic Syndrome / blood
  • Hemolytic-Uremic Syndrome / diagnosis
  • Hemolytic-Uremic Syndrome / drug therapy
  • Hemolytic-Uremic Syndrome / etiology
  • Hemolytic-Uremic Syndrome / therapy*
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Kidney / pathology
  • Lupus Nephritis / complications*
  • Lupus Nephritis / drug therapy
  • Methylprednisolone / therapeutic use
  • Models, Immunological
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Plasma Exchange*
  • Prednisone / therapeutic use

Substances

  • Immunosuppressive Agents
  • Hydroxychloroquine
  • Cyclophosphamide
  • Mycophenolic Acid
  • Prednisone
  • Methylprednisolone