Table 1.
Clinical and laboratory profile of the three patients
| Patient A | Patient B | Patient C | |
| Age of SLE diagnosis | 28 | 14 | 32 |
| Ethnicity | African | Indian | Asian |
| Features at SLE diagnosis Cutaneous Arthritis Serositis Neurologic Haemolytic anaemia Leucopenia Thrombocytopenia |
+ + + − + − − |
+ + + – – – – |
– + – – – + – |
| Initial serology ANA Pattern Anti-dsDNA Anti-Ro C3 (g/L) Anticardiolipin IgM IgG DRVVT |
>1:320 Diffuse + + 0.69 – – – |
>1:320 Speckled+diffuse + + 1.21 – – – |
>1:320 Nucleolar+diffuse + + 1.11 – – – |
| Progress of SLE (non-renal) |
Multiple arthritis flares (2003–2010) First trimester miscarriage (2007) Pleurisy (2009) Myocarditis (2009) Renal abscesses (2010) Pyelonephritis (2010) |
Multiple arthritis and rash flares (2006–2017) Vasculitis in fingers and toes (2007/2012) Alopecia (2007) Dyspnoea, mouth ulcers and headaches (2008) Shingles and chest infection (2008) Acute liver injury secondary to NSAIDs (costochondritis) (2016) |
Multiple arthritis flares (2005–2017) Discoid lupus (2005) Raynaud (2008) Pneumonia (2014) Pulmonary cysts and calcified nodules (2015) Rash (2017) |
| Initial renal tests Serum creatinine (µmol/L) eGFR (mL/min/1.73 m2) Proteinuria Haematuria Urinary protein/creatinine ratio (mg/mmol) |
75 97 – – 5 |
70 95 – – 8 |
63 95 – – 3 |
| Features suggesting renal involvement Hypertension Proteinuria Haematuria Serum creatinine (µmol/L) eGFR (mL/min/1.73 m2) Urinary protein/creatinine ratio (mg/mmol) Oedemas |
+ +++ ++ 190 30 438 + |
+ ++++ +++ 83 69 986 + |
– +++ ++ 89 59 273 – |
| Biopsy findings | Very active diffuse proliferative changes | Patchy background parenchymal oedema. No chronic damage. Mix pattern immune complex glomerulopathy. Endocapillary and extracapillary active proliferation and membranous change | Very active diffuse proliferative changes |
| WHO LN class | IV | IV+V | IV |
| Time of LN diagnosis in years after SLE diagnosis | 19 | 17 | 15 |
| Therapeutic for LN Prednisolone Cyclophosphamide Mycophenolate mofetil Rituximab |
+ – + – |
+ – + + |
+ – + + |
| Outcome of LN Duration of follow-up |
Partial remission with evolution to chronic kidney disease 5 years |
Complete remission 4 months |
Active 2 months |
DRVVT, dilute Russell viper venom time; eGFR, estimated glomerular filtration rate; LN, lupus nephritis; NSAID, non-steroidal anti-inflammatory drug.