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 (α-
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.