A 37 yrs female came in opd c/o swelling below both eyes and h/o taken tablet augumentin since 15 days.

Hello dear friends One case of my relatives came to me A 20 yrs unmarried female with c/o oedema over whole body since she was 2.5 yrs of age they consulted to a Dr and taken treatment after that she was obsulately fine after that again oedema started on 7 yrs of her age with pain in abd after treatment again all the oedema subsided again on 13 yrs of her age she started with same complaint and now she is 20 yrs and wt is 65 kg now c/o mild oedema over face and this oedema gows on increasing to whole the face and also in few days pedal oedema can be noticed menstural history is regular N/H/O ,DM /Thyriod/ TB/ no any familial history they are consulting to a nephrologist attaching blood reports and biopsy report plz have a look and suggest the further management

RENAL FEATURES OF SLE/SLE NEPHRITIS. Lupus nephritis is inflammation of kidneys caused by SLE.Systemic lupus erythematosus is an auto immune disease in which the body's immune system attacks the body's own cells and organs.SLE nephritis gets worse over time and leads to renal failure. Lupus is more common in woman than in men. 9 out of 10 lupus patients are women.It most often strikes during child bearing years.Lupus is also more common in poeple of asian or african background. SYMPTOMS OF LUPUS NEPHRITIS. 1.Sudden ,unexplained swelling ,especially in the extremities-feet,ankles,legs,fingers,arms or eyes. 2.Hematuria. 3.Elevated blood pressure. 4.Foamy appearance in urinedue to proteinuria 5.Increased urination ,especially at night. HYPERTENSION,HEMATURIA,PROTEINURIA, EDEMA &WEIGHT GAIN CLASSIFICATION OF LUPUS NEPHRITIS. Lupus nephritis is staged according to the classification revised by the international society of nephrology (ISN) amd Renal pathology society (RPS).in 2003.The classification is based on light microscopy, immunoflorescence and electron microscopy findings from renal biopsy specimens. ISN/RPS CLASSIFICATION CLASS I : MINIMAL MESANGIAL LUPUS NEPHRITIS. Histological features. *Normal glomeruli on light microscopy. *Mesangial immune deposits on immunoflorescence. CLASS II : MESANGIAL LUPUS NEPHRITIS. Histological features. Mesangial hypercellularity with mesangial immune deposits on immunoflorescence. CLASS III : FOCAL PROLIFERATIVE. LUPUS NEPHRITIS. Histological features. Focal proliferative glomerulonephritis involving <<50% of glomeruli.,typically with focal sub- endothelial immune deposits and leucocyte infiltration. CLASS IV : DIFFUSE PROLIFERATIVE LUPUS NEPHRITIS. Histological features. Diffuse proliferative glomerulonephritis involving >>>50 % of glomeruli ,typically diffuse sub -endothelial immune deposits. CLASS V : MEMBRANOUS LUPUS NEPHRITIS Histological features. Thickening of capillary walls. Global/segmental sub-epithelial immune deposits. CLASS VI : ADVANCED SCLEROSIS LUPUS NEPHRITIS. Histological features. Irreversible advanced disease. >>>90 % glomerulosclerosis. PATHOPHYSIOLOGY OF SLE Multiple influences are thought to underlie the pathogenesis of SLE like 1.Genetic factors. 2.Epigenetic modifications. 3.Environmental triggers. 4.Hormonal influences. 5.Aberrant immune mechanismslike Adaptive immune dysfunction. Innate immune dysfunction. LABORATORY DIAGNOSIS. Laboratory tests to evaluate renal function in SLE are 1.Blood urea nitrogen (BUN ) testing. 2.Serum creatinine assessment. 3.Urine analysis - to check for protein,RBC casts, and cellular casts. 4.Spot urine test for creatinine and protein concentration. Laboratory tests to evaluate SLE disease activity are 1.Antibodies to double stranded DNA (ds DNA) 2.Complement(C3,C4,and CH50.). 3.ESR. 4.C-reactive protein.(CRP). RENAL BIOPSY is considered in any patient with SLE who has clinical or laboratory evidence of active nephritis ,especially upon the first episode of nephritis . MANAGEMENT. THE PRINCIPAL GOAL OF THERAPY IN LUPUS NEPHRITIS IS TO NORMALISE RENAL FUNCTION OR,ATLEAST ,TO PREVENT THE PROGRESSIVE LOSS OF RENAL FUNCTION. Key points of American college of Rheumatology guidelines for managing lupus nephritis are as follows 1.Patients with clinical evidence of active, previously untreated lupus nephritis should have a RENAL BIOPSY to classify the disease according to ISN/RPS criteria. 2.All patients with lupus nephritis should receive background therapy with HYDROXYCHLOROQUINE ,unless contra indicated. 3.GLUCOCORTICOIDS along with CYCLOPHOSPHAMIDE intra venously (OR ) MYCOPHENOLATE MOFETIL orally should be administered to Patients with CLASS III/IV disese. Patients with class I/II nephritis do not require immunosuppressant therapy. 4.ACE INHIBITORS/ANGIOTENSIN RECEPTOR BLOCKERS should be administered if proteinuria exceeds 0.5 gm/day. 5.B.P should be maintained below 130/80 mm Hg. Patients with CLASS V. lupus nephritis are generally treated with prednisone for 1-3months ,followed by tapering for 1-2 years , if a response occurs. INVESTIGATIONAL THERAPIES FOR SLE NEPHRITIS. 1.Rituximab 2.Other anti-CD20 monoclonal antibodies like Ocrelizumab. Ofatumumab. Epratuzumab. TRU-015. 3.Belimumab. 4.Atacicept. 5.Abetimus. 6.Anti-cytokine therapies. Patients with end stage renal disease require DIALYSIS and are good candidates for RENAL TRANSPLANTATION.Hemodialysis is preferred to peritoneal dialysis. MY DOUBT: WONT THAT TRANSPLANTED KIDNEY BE AFFECTED BY SLE?????

A young boy aged 13 years p/w complaints of Gradual onset decreased Urine output and Generalised Edema more below the eyes since 2-3 months....No history of Fever or any drug intake is present...At presentation, he was found to have Anasarca and b/l pleural effusion and ascites...his reports are displayed....determine the treatment approach to this patient and how shd he be treated...

33 yr old female pt comes with h/o multiple joint pains & rash over the face, o/e no obvious joint deformities. systemic exam - normal. how to approach this case ?