1. Systemic Lupus Erythematosus Sheelendra Shakya Dept. of Pediatrics, KMCTH

6. Pathogenesis

11. Investigations CBC: TC 3500 N63L36M1;Hb 6.9gm%; PLT 42000/cumm ESR 72mm in 1 st hour Peripheral Smear: normocytic, normochromic to mildly hypochromic e mild anisocytosis. Plt reduced on smear Biochemistry: Urea 96mg/dl Cr 1.1mg/dl; Na 123meq/L, K 4meq/L Total protein: 4.3g/dl Albumin: 3.6g/dl Total Cholesterol 210 mg/dl HDL: 27mg/dl Triglycerides: 697mg/dl LDL could not be calculated. ANA , CRP, ASO, RA factor- negative Urine: pus 6-8/hpf, RBC plenty; Albumin 2 +, cast 0-2 24 hour urine volume: 350ml 24 hour urinary protein 2717mg. Urine C/S- insignificant bacteriuria Montoux test: no induration after 72 hrs Reticulocytes: 4% Albumin repeated after 2 weeks: 1.8mg/dl Anti-dsDNA by ELISA- positive (69.12 IU/ml) USG: B/L medicorenal disease B/L pleural effusion Minimal pericardial effusion. Ascites CXR: B/L pleural effusion Repeat Urine RMEs: persistent albumin, RBC and pus cells.

20. Cardiac

26. Useful Investigations

28. International Society of Nephrology 2003 classification of lupus nephritis Chronic lesions and sclerosis Advanced sclerosing Class VI Predominantly nephrotic disease Membranous Class V >50% of glomeruli involved Diffuse proliferative Class IV <50% of glomeruli involved Focal proliferative Class III Hypercellular on light microscopy Mesangial proliferative Class II Normal light microscopy findings, abnormal electron microscopy findings Minimal mesangial Class I

44. Thank you