A patient　with　severe　lupus　nephritis　who　developed　chronic　renal　failure　after　non-compliance　of　medicine

Abstract

This　case　involved　a　15-year-old　girl　with　critical　systemic　lupus　erythematosus（SLE）from　11 years old．　Her　first　renal　histopathological　finding　was　IV-G（A）according　to　the　ISN/RPS　classification．　In　a　previous hospital,　she　had　been　treated　using　oral　steroid，methylprednisolone　pulse　therapy，cyclophosphamide　pulse therapy　and　other　immunosuppressive　drugs（mizoribine　and　cyclosporine）．　However，　nephrotic　state　continued， and　renal　function　showed　a　tendency　toward　slow　exacerbation．　She　was　referred　to　our　hospital　for　the　purpose of　long-term　management，including　future　dialysis，in　October　2007．Her　character　at　this　time　was　taciturn　and unsociable．　After　transfer　to　our　hospital，　we　suspected　non-compliance　with　the　medication　regime，based　on　the results　of　blood　chemical　testing．We　only　continued　ambulatory　treatment　while　suspecting　non-compliance，as her　clinical　condition　was　stable．　However，　her　SLE　recurred　from　autumn　2008，　while　renal　function　suddenly worsened　and　progressed　to　chronic　renal　failure　requiring　hemodialysis．The　etiology　of　sudden　exacerbation was　non-compliance　with　medication，as　we　had　suspected．　Compliance　can　be　difficult　to　achieve　in　pubertal patients　with　SLE（particularly　pubertal　female　patients），and　we　should　have　hospitalized　her　and　introduced counseling　earlier.