Lupus in fabula - hipertenzija mlađeg muškarca i sistemski lupus eritematozus

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects women during the reproductive period (the ratio of female to male is 9 to 1). Although SLE can affect any organ, glomerulonephritis mediated by immune complexes lead to a sudden deterioration of the disease. The literature data indicate the role of chronic inflammation in the pathogenesis of arterial hypertension (HTA) in patients with SLE. This is a case study of a young man with a newly diagnosed HTA, with lupus nephritis behind. The data were obtained retrospectively, by analyzing the patient's medical record. A 40-year-old patient, with a two-year history of irregular and unsuccessful treatment of HTA with ACE inhibitor, saw his doctor for frequent headaches and elevated arterial blood pressure (TA) during self-measurement. By physical examination an auscultatively accelerated cardiac action was found, TA was 170/100 mmHg, and the ECG registered sinus tachycardia (about 100 bpm), while the rest of the finding was neat. Anamnestic data revealed that patient was recreational athlete, a non-smoker, and there was no positive family history of cardiovascular disease. Laboratory report of blood and urine was without significant deviation. Beta blocker and thiazide diuretic were used in the therapy. A month later lower leg edema appeared, followed by highly elevated TA values (up to 200/110 mmHg) and maculopapular rash. The patient was sent to the internist, and then hospitalized at the department of allergology. During the hospitalization, additional diagnostics was made. Laboratory finding reported sudden renal impairment and anemia (creatinine 144 mmol/L, urea 15.8 mmol/L, proteinuria 9.4 g/day, hemoglobin 106 g/L), and immunological analyzes indicated the positivity of SLE specific antibodies (ANA 1:160; anti-dsDNA 1:320). The patient was moved into the nephrology department where the treatment was initiated by the bolus of methylprednisolone (3x500mg). Under the control of ultrasound, a biopsy of the kidneys was performed, and the pathohistological finding showed lupus nephritis of class IV-G (A / C), activity index 17 and chronicity index 4, of the total of eight analyzed glomeruli one was globally sclerotic and in 3 glomeruli found crescent. Cyclophosphamide bolus therapy was started, and patient was released in a well general condition with prescribed corticosteroid and antihypertensive therapy - ACE inhibitor, calcium-channel blocker, Henle's loop diuretic, and beta blocker. Understanding the pathophysiology of HTA in this chronic autoimmune disease is of great clinical significance for patients suffering from SLE, as the cardiovascular disease is still the main cause of mortality with these patients.