Termination of Hemodialysis Treatment on the 5th Month of Mycophenolate Mofetil in Type 4 Lupus Nephritis with Serious Renal Failure: A Case Report

Systemic lupus erythematosus (SLE) is a chronic, occasionally life-threatening, multisystem disorder, and renal involvement is one of the most common and most serious complications of SLE. Among the various histological types of lupus nephritis, diffuse proliferative nephritis carries the worst prognosis. A 28-year-old woman was admitted to Baskent University Adana Hospital with the complaints of dyspnea, chest pain, and fatigue. The patient had active lupus manifestations including generalized pleural and pericardial effusion, hypoalbuminemia, anemia, leucopenia, hypocomplementemia, markedly elevated ANA, acute kidney injury, and uncontrolled hypertension. Renal biopsy had been performed at another institute and shown type 4 lupus nephritis. She had been managed with methylprednisolone and cyclophosphamide (CYP) for 6 months. We started immunosuppressive therapy with intravenous methylprednisolone (1 gr/day) for 3 days as an induction therapy. The treatment was continued with oral methylprednisolone 0.5 mg/kg/day and mycophenolate mofetil (MMF) 1 gr/day. Hemodialysis (HD) therapy was initiated because of progressive renal failure and hypervolemia during the clinical course. Despite the improvement in her general condition, the patient underwent HD treatment three times a week for 5 months. On the fifth month of MMF therapy the renal function and diuresis were progressively improved and HD treatment was terminated. Management with MMF may be effective for remission of lupus nephritis in patients who are nonresponders to initial CYC therapy.