Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.
Blood Purif. 2022;51(2):182-188. doi: 10.1159/000512585. Epub 2021 Apr 23.
In patients with systemic lupus erythematosus (SLE), disease activity can persist even after initiating dialysis. However, guidelines for the treatment of patients with SLE after dialysis is initiated have not yet been established.
We describe the case of a 54-year-old Japanese woman who was diagnosed with SLE at age 12, progressed to end-stage renal disease (ESRD), and initiated hemodialysis for lupus nephritis. However, SLE activity persisted after hemodialysis. Cyclophosphamide and mycophenolate mofetil were administered in addition to prednisolone and immunoadsorption, but this treatment strategy was limited by side effects. The patient was subsequently treated with belimumab, and the activity of SLE decreased rapidly.
ESRD patients with SLE show no significant decrease in transitional B cells and have elevated levels of B-cell activating factor (BAFF). Both transitional B cells and BAFF are important therapeutic targets for belimumab, indicating that patients with ESRD may benefit from belimumab therapy. However, the effects of belimumab may be potentiated in patients with uremia, who may be more susceptible to adverse events such as infections. Patients with SLE who receive belimumab after initiation of hemodialysis therefore require careful follow-up. Here, we report the first case of belimumab administration in a patient with SLE after initiation of hemodialysis.
在系统性红斑狼疮（SLE）患者中，即使开始透析后，疾病活动仍可能持续存在。然而，尚未制定针对开始透析后 SLE 患者的治疗指南。
我们描述了一位 54 岁的日本女性病例，她在 12 岁时被诊断出患有 SLE，进展为终末期肾病（ESRD），并因狼疮肾炎开始接受血液透析。然而，血液透析后 SLE 仍持续存在。除了泼尼松龙和免疫吸附外，还给予了环磷酰胺和霉酚酸酯，但由于副作用，该治疗策略受到限制。随后，患者接受了贝利尤单抗治疗，SLE 活动迅速下降。
ESRD 合并 SLE 患者的过渡性 B 细胞无明显减少，B 细胞激活因子（BAFF）水平升高。过渡性 B 细胞和 BAFF 均是贝利尤单抗的重要治疗靶点，表明 ESRD 患者可能受益于贝利尤单抗治疗。然而，在尿毒症患者中，贝利尤单抗的作用可能增强，这些患者更容易发生感染等不良事件。因此，开始血液透析后接受贝利尤单抗治疗的 SLE 患者需要密切随访。在这里，我们报告了首例开始血液透析后接受贝利尤单抗治疗的 SLE 患者。
