Thank you for your query at DoctorSpring.com
SLE is a systemic disease which involves several parts of the body and affects the young women predominantly( unfortunately).
I felt that she has been diagnosed with lupus nephritis a bit late as evidenced by significant chronicity index. It suggests that the damage to the has a permanent features in that and they are likely to progress. Activity index suggests that she would require the higher immunosuppression which she received in the form of rituximab. She has been taking all drugs appropriately except a slightly higher dose of steroids, which can lead to few steroid complications. We dont have to look at the raising creatinine alone to increase the immunosuppression drugs as she is adequately immusuppressed. there should not be any knee jerk reaction to increasing creatinine. She should have been given Inj Cyclophosphamide before itself instead of rituximmab but must have been with held looking at the younger age. (Did she conceive before ? how many children does she have?).
Prognosis would be not so good as immunological destruction can take any turns and i feel that she should be doing good with MMF. Excess immusosupressive drug therapy can put her in to unnecessary complications also. We should weight risk versus the benefit. T She has a tendency to progress very slowly and dont get disheartened by looking at the creatinine alone as she can be stable at the same creatinine level for several years unless you change the drugs on your own , switch over to alternative forms of therapies etc. ( please don't do that as they are very harmful to kidneys).
Feel free to discuss further,
Patient replied :
Thanks for your reply.
I just want to know what MMF (mentioned in your kind answer) stands for?
Second I just want to give you further information which mighr give you wider picture about activity and spreading of the disease.
her weight was 51 kg at the time of disease diagnosis 3 years ago.
Her weight went up to 69 kg after putting her on treatments including steroid. 3 months ago she suffered from nausea and vomiting (she has been told that disease is active and starts to involve GIT and gut). As a result, her weight went down yo 61kg.
her doctor now wants to put her on Solumedrol 1g followed by cudophosphamide 1gram.
what do you think about this treatments? If they are suitable for her case, what is the proper dose and for how long?
Do you have any other treatment suggestions or alternatives?
Finally, can I please know your name and breif information about you?
MMF stands for mycophenolate mofetil. It can produce loose stools and stomach pain e.t.c but otherwise effective and safe.
Steroids can produce such a weight gain and few more complications related to that. Steroids should be given carefully and cautiously to avoid such complications and effective use. I personally feel that solumedrol and 1 gm of cyclophosphamide are a bit high and as I told you that along with the impulse increase in immunosuppressive can be harmful and futile. According to me MMF is the best alternative.
Dr. Sree Bhushan Raju, DM Nephrology.
Patient replied :
Hi Doctor In your answer you said that MMF is the best alternative for cyclophosphamide. I think she is already on MMF. so what other suggessions you reccomend? Rituxamab for example? What dose and for how long?
Yes. MMF is good compared to all other drugs in maintenance therapy. Better not to give rituximab again. There is a kind of damage took place already demonstrated by chronicity index. As I said, any knee jerk reaction in hiking the immunosuppression would result in complications rather than of any use. She requires to be on 2 gm per day of MMF initially followed after few months by 1.5 gm per day. HCQ and a statin , vitamin D etc are useful.
BP control and weight reduction would make the kidney better. Wait and watch creatinine and if required ( in case of slightly rapid rise of creatinine would require kidney biopsy again )
Dr Sree Bhushan Raju