Abstract
Systemic lupus erythematosus (SLE) is a multi-systemic disease occurring predominantly in young women. The diagnosis of SLE is especially difficult in patients older than 50 years because the characteristic clinical manifestations are lacking. In aged SLE patients, arthritis, pleuropericarditis and muscle weakness are frequently observed, but severe renal lesions rarely exist. We report the case of a 65-year-old man who suffered from rapidly progressive glomerulonephritis which caused renal insufficiency. Renal biopsy specimen showed diffuse glomerulonephritis with active necrotizing lesions (Class IV-b WHO classification).
Circulating immune complexes were elevated, as detected by C1q solid phase ELISA, but the complement levels were normal and anti-DNA antibodies were not observed. He was administrated orally 20mg/day of predonisolone and 50mg/day of azathioprine, and treated by double filtration plasmapheresis (DFPP) once a week. These therapies were effective and he required no more hemodialysis. In this patient, the concentration of circulating immune complexes seemed to correlate with the renal damage. DFPP improved his renal function, probably by eliminating these immune complexes.
