This case presentation describes a 22-year-old male patient who presented with swelling of the lower limbs and puffy eyelids for 3 months. Tests showed elevated renal function and proteinuria. Immunological markers were positive for SLE but a renal biopsy was not initially performed. The patient was started on steroids without a confirmed lupus diagnosis and required hemodialysis for volume overload. After several transfers, the patient arrived at the present hospital where a renal biopsy was finally done, though the results are not included. The take home message emphasizes the importance of performing a baseline renal biopsy in SLE patients to avoid inappropriate management that could worsen outcomes.

1. CASE PRESENTATION
BY
DR. MAHMOUD ISMAEL
NEPHROLOGY RESIDENT
NMGH

2. PERSONAL HISTORY
22 year old male patient,
single with no special habits
of medical importance
,serving at armed forces
sience 8 month.

3. COMPLAINT
swelling of both lower limb
&puffiness eye lid since 3
months

4. PRESENT HISTORY
Condition started 3 months ago by
sudden onset and progressive course of LL
edema & puffy eye lid with persistent HTN .
The ptn referred to armed hospital, on
examination ptn had elevated renal function tests
and proteinuria was detected.

5. PRESENT HISTORY
• Immunological markers were positive such as
• Decreased C3, C4
• Positive ANA
• Positive Anti DNA
• unfortunately renal biopsy was not done &
steroid started ???
• Steroid was started empirically with out lupus
classification in a dose of 20 mg / day.
• HD was initiated due to volume overload.

6. TREATMENT
• Alfa methyl dopa 250 mg 2x3
• Captopril 25 mg 1x3
• Amlodipine 10 mg 1x1
• Metolazone 5mg 1x1
• Methyl prednizolone20 mg 1x1

7. PRESENT HISTORY
• the ptn maintained On regular HD which lead to
reduction of his body weight 20 kg & become dry.
• Then ptn referred to El Maady Armed Hospital for
renal biopsy.
• Then to Tanta University Hospital, then to Mansoura
Urology And Nephrology Centre,
• Lastly to our hospital at 9/4/2017(3 months later from
the onset of complaint).

8. EXAMINATION
• Patient conscious, oriented to time place &
persons
• Bp 160/80
• No LL edema or puffy eye lid
• Chest clear

9. PAST HISTORY
• NO PAST HX OF MEDICAL
IMPORTANCE.

10. FAMILY HISTORY
• His sister Is SLE.
• No other family history.

11. INVESTIGATION
CREAT. : 5.6
URINALYSIS: ALB. +4
ALBUMIN: 2.8
HB : 11.9
INR: 1.05
ESR: 10 25
CRP: -VE
C3: 66
C4: 27
Anti DNA: -VE
ANA: -VE

13. INVESTIGATION
ABD. US:
size both kidney (14x5)(14.5x6) with
mild increase echogenicity &
preserved CMD

14. NEXT STEP
We prepare
ptn for Renal
biopsy which
was done.

15. BIOPSY
???

16. ESRD

17. TAKE HOME MESSAGE
- Postponing basal biopsy in ptn SLE may mask
the underlying pathological lesion which may
result in inappropriate management that may
worsen the outcome and progression of the
case.
- Although the percentage of the risk of SLE is
(9:1) female: male ,but it dose not exclude SLE
in male even with negative immunological
markers.

18. THANK YOU