Abstract
A 74-year-old man with diabetes mellitus, hypertension and dyslipidemia was referred to our department due to the deterioration of renal function, proteinuria and hematuria. From his symptoms and laboratory findings, we suspected systemic lupus erythematosus (SLE) and planned an additional examination. However, he was admitted to our hospital due to fever and acute renal failure with severe hyperkalemia before the next consultation day. Acute exacerbation of lupus nephritis was suspected. We started oral prednisolone with continuous hemodialysis for the treatment of the hyperkalemia. Since his symptoms and examinations fulfilled the diagnostic criteria of SLE, he was diagnosed with late-onset SLE and lupus nephritis. Although his condition improved after the treatment with prednisolone, pancytopenia and hypocomplementemia were not improved. We then added mizoribine to the prednisolone. However, the pancytopenia and hypocomplementemia continued. We therefore initiated immunoadsorption plasmapheresis (IAPP). After this IAPP treatment, his symptoms and laboratory findings improved without recurrence. This case indicates that IAPP is one of the effective options for the treatment of lupus nephritis, especially in elderly patients, to lower the risk of immunosuppressant-related adverse events.
