Dr ibrahim alawaad case

1. 
By
Ibrahim Elawaad
Egyptian Nephrology Fellowship Trainee
Nephrology Department
New Mansoura General Hospital
Case Presentation

2. 
Male patient, 19 years old, student
from Kafr Elshiekh, single with no
special habits of medical importance.
Personal History

3. 
Pallor.
Easy fatigability .
Oliguria.
Compliant

4. 
The condition started since 8 years by
skin rash and echomosis and malar rash
and diagnosed by systemic lupus.
Increased creatinine gradually reached
now 11.2 mg/dl and his basal creatinine
3.8 mg/dl.
He has been admitted to our hospital to
complete his investigation and follow up.
History of Present Illness

5. He had taken 4 session of hemodialysis
due to moderate pericardial effusion and
metabolic acidosis and low GFR.
He prepared for biopsy and resulted in LN
WHO Class IV activity 5/24 and chronicity
10/12 .

6. SLE since 8years and LN since 6 years 2
times biopsyes on 2011 show early
membranous nephropathy & 2017 (WHO.
Class IV).
. Hypertension for 4 years on concor 10.
No past history of similar condition.
No previous surgical intervention.
Past History

7. 
No auto immune diseases.
Dm
Htn
FamilyHistory

8. 
The patient is pallor, looks ill
Pulse: 100
BP : 140/80
RR : 24
Temp: 37.2
General Exam.

9. 
Chest: decreased air entry on both sides
Heart : tachycardia
LL edema below knee
No Cyanosis
Local exam

10. 
CBC
• WBCs = 6.2
• Hb =7.7
• Plt = 206
Blood Chemistry & electrolytes
• Creat. = 11.2
• Urea = 288
• Na = 124
• K= 4.2
• ABG
• Ph 7.2
• Pco2 20
• Hco3 10
Investigations

11. 
Urine analysis:

12. 
Chest X-ray

13. 
Pelvi-abdomial u/s

14. 
-
Echocardiography

15. 
Biopsy

16. 

17. 
Lupus Nephritis ISN/RPS Classification

18. 

19. 
 Solumedrol 500 for 3 day.
 Solupred 20 after pulse steroid.
 Cellcept 500 bid.
 Hydroquine 200.
 Erithropiotin
 Concor 10.
 Amlodipine 10.
Treatment

20. 

21. 
CBC
• WBCs = 5,3
• Hb =7.4
• Plt = 38
INR = 1.52
(2nd day of admission)

22. 
ABG
PH = 7.33
HCO3 = 12.1
PCO2 = 23
PO2 = 83
O2 sat. = 95 %

23. 
Any case with this presentation LN:
Evaluation of the kidney by kidney
function tests and ultrasound and do
biopsy if deterioration happened.
Seek for other comorbidity as pericaditis
and uremic Encephalopathy .
Conclusion

24. 
systemic lupus erythematosus criteria

25. 
Best Wishes