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2015 ; 5
(1
): 106-12
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Radical improvement of signs and symptoms in systemic lupus erythematosus when
treated with hemodiafiltration with endogenous reinfusion dialysis
#MMPMID26034748
Solano FG
; Bellei E
; Cuoghi A
; Caiazzo M
; Bruni F
Case Rep Nephrol Dial
2015[Jan]; 5
(1
): 106-12
PMID26034748
show ga
Lupus nephritis is one of the most serious complications of systemic lupus
erythematosus (SLE). In the kidney, immune complexes and autoantibodies activate
mesangial cells that secrete cytokines that can further amplify inflammatory
processes. We present the case of a 42-year-old woman with lupus nephritis
accompanied by periods of exacerbation of SLE, with necrotic-like skin lesions,
psoriatic arthritis without skin psoriasis, purpura of the lower limb, petechial
rash, joint pain, fever, eyelid edema with bilateral conjunctival hyperemia and
itching. The patient underwent a dialytic treatment of hemodiafiltration with
endogenous reinfusion. The technique uses the super-high-flux membrane Synclear
02 (SUPRA treatment) coupled with an adsorbent cartridge that has affinity for
many toxins and mediators. Fever and joint pain were immediately reduced after
treatment and, subsequently, there was a notable reduction of the skin damage.
Prednisone and immunosuppressive drugs were gradually reduced until complete
suspension. High-performance liquid chromatography coupled with quadrupole
time-of-flight mass spectrometer was performed for identification of proteins
captured by a resin bed during a dialysis session of the patient. This technique
identified several biomarkers of kidney injuries, uremic toxins, fragments of
immunoglobulins, antigens involved in antiphospholipid syndrome and a new marker
(?-defensin) that correlated significantly with disease activity. The removal of
these different proteins could possibly provide an explanation of the improvement
in the patient's symptoms and the normalization of her SLE. SUPRA coupled with an
adsorption may be a promising new technique for the treatment of lupus nephritis.