A case　of　17-year-old　girl　treated　with　plasma　exchange　therapy　for lupus　nephritis　exhibited　nephrotic syndrome．

Abstract

The　patient　ill　this　case　was　a　17-year-old　girl　with　systemic　lupus　erythematosus （SLE)．　Ten　years　after onset, the　SLE　recurred　accompanied　by　nephrotic　syndrome．　Lupus　nephritis　of　International　Society　of Nephrology　class　lV　G（A/C）was　diagnosed　according　to　kidney　biopsy　results．　The　patient　underwent　4 courses　of　steroid　pulse　therapy．　but　her　urinary　protein　levels　gradually　increased．　Her　systemic　symptoms included　marked　edema　and　accumulation　of　pleuroperitoneal　and　pericardial　fluids．　She　was　admitted　to　the hospital　at　age　17 years　6　months．　Plasmapheresis　was　performed　to　eliminate　autoantibodies，which　improved the　nephrotic　symptoms　and　relieved　the　edema　and　accumulated　pleuroperitoneal　and　pericardial　fluids． Thereafter，the　urinary　protein　levels　gradually　decreased．　Cyclophosphamide　pulse　therapy　was　selected　as maintenance　immunosuppression　therapy．　After　8　months，　remission　of the　nephrotic　syndrome　was　achieved、 　　　Lupus　nephritis　is　a　serious　complication　of　SLE，　which　can　be　a　determining　factor　of　patient　quality of　life　and　prognosis．　In　addition　to　steroids，　combined　use　of　mycophenolate　mofetil　and　cyclophosphamide pulse　therapy　is　necessary　for　the　treatment　of　lupus　nephritis　class　IV．　In　severe　cases　of　nephrotic　syndrome， plasmapheresis　is　considered　as　all　effective，　life-saving　treatment　in　the　acute　phase．