Boey, Olivier

Bogaert, Anne-Marie

De Scheerder, Marie-Angélique

Mahieu, Elien

Vanuytsel, Johan

English

Ghent University Academic Bibliography

Case history Renal biopsy confirmed diagnosis of lupus nephritis class V.  Ophtalmic exam showed active vasculitis in both eyes. Clinical and diagnostic  features (joint pain, dacryoadenitis, retinal vasculitis and lupus nephritis) in combination with serology (positive anti-DNA antibodies, hypocomplementemia) confirmed diagnosis of systemic lupus erythematosus. Index for activity and severity (BILAG and SELENA/SLEDAI) showed a BILAG A for renal/neurological/muco-cutaneous, a B for musculo-skeletal with  a SELENA-SLEDAI index of 24 points.   Diagnosis Copy and paste our text content here, adjusting the font size to fit. Conclusion For the Eye Altering, Alters the All De Scheerder M-A, M.D.¹, Mahieu E., M.D.²³, Boey O., M.D. ²³, Vanuytsel J., M.D.²³, Bogaert A-M, M.D. ²³ General Internal Medicine, UZ Gent, Gent ¹, Department of Nephrology, Sint-Elisabethziekenhuis, Zottegem², AZ Glorieux , Ronse³   References Printed by Biopsy results  A 26-year-old African female  presented initially with chronic dacryoadenitis, resistant to both topical and systemic treatment with short courses of antibiotics and corticosteroids. Screening for underlying systemic condition  revealed nephrotic range proteinuria (2,72g/24u ).  . Gerald B. Appel*, Gabriel Contreras † , Mary Anne Dooley ‡ et all, Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis, JASN May 2009 20: 1103-1112 Navarra SV, et al: Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet 2011, 377(9767):721-731 Susan Manzi1, Jorge Sánchez-Guerrero2, Joan T Merrill3 Effects of belimumab, a B lymphocyte stimulator-specific inhibitor, on disease activity across multiple organ domains in patients with systemic lupus erythematosus: combined results from two phase III trials, Ann Rheum Dis 2012;71:1833-1838 Bevra Hannahs Hahn, Belimumab for Systemic Lupus Erythematosus, N Engl J Med 2013; 368: 1528-1535 Dooley MA1, Houssiau F, Aranow C, Effect of belimumab treatment on renal outcomes: results from the phase 3 belimumab clinical trials in patients with SLE, Lupus. 2013 Jan;22(1):63-72  Fig 2: light microscopy, silver staining : clear visualisation of the thickened basal membrane and appearance of ‘spikes’ (formation of perpendicular projections of material similar to the glomerular basement membrane (GBM) in the external part of this one (between  podocyte cytoplasm and GBM)    Fig 1: light microscopy: PAS staining: normal structure of the glomeruli, no proliferation, thickening of the basal membrane due to subepithelial immune deposits  Management and outcome  Treatment was immediately initiated with glucocorticosteroids (GCS), mycophenolate mofetil (MMF) and Hydroxychloroquine sulphate (Plaquenil®). Tacrolimus was associated but no effect was observed with the proteinuria remaining in nephrotic range and secondary effects of the glucocorticosteroids becoming a real concern. Patient was started on add-on belimumab with quasi-immediate effect on the proteinuria, making it possible to reduce the dose of the other immunosuppressants and gradually stop them, even the GCS.                                                                                  Discussion  Conclusion This case shows excellent results of belimumab in lupus nephritis with persistent nephrotic range proteinuria under conventional treatment. The bilateral ocular vasculitis, resistant to the initiated treatment, also responded to the initiation of belimumab but remission was only obtained after 6 months. Alternatives are scarce and mostly limited due to toxic effects and by failure to control disease.   Whether belimumab has a role in the treatment of CNS lupus or active lupus nephritis is still unknown, since these patients were excluded from the BLISS trials. However in those trials, 267 patients had renal involvement and treatment in this group was associated with significant improvement in proteinuria. A phase 3 study (BLISS-LN) is recruiting patients with lupus nephritis since these post-hoc analysis of the BLISS trials suggest that belimumab may offer renal benefit in patients with SLE.  Treatment schedule  

For the eye altering, alters the all

https://biblio.ugent.be/publication/7055096/file/7055097

For the eye altering, alters the all

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