Ebrahimi Niloufar, Geetha Duvuru, Reyes-Bahamonde Joselyn, Zuppan Craig W, Abdipour Amir, Norouzi Sayna
Department of Medicine, Division of Nephrology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA.
J Nephrol. 2025 Aug 8. doi: 10.1007/s40620-025-02361-y.
Lupus nephritis (LN) is the predominant severe manifestation of systemic lupus erythematosus (SLE). The approach to managing LN is highly heterogeneous due to the clinical heterogeneity of the disease. Here, we report a 28-year-old Caucasian female with refractory biopsy-proven active LN class III and V, diagnosed approximately six years prior to presentation who was successfully managed with both belimumab and voclosporin. Her laboratory findings were significant for high-titer anti-dsDNA antibodies (> 300), low complements, and increasing proteinuria despite ongoing treatment with MMF and low-dose prednisone. The patient fulfilled the EULAR/ACR classification criteria for SLE, achieving a score of 28, reflecting significant systemic disease involvement. The patient tolerated the combination of volcosporin and belimumab well for nine months. She did not report any specific side effects during this time and was in clinical remission with no signs of systemic flare-up based on the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). This case highlights the potential of combining belimumab, voclosporin, mycophenolate mofetil (MMF), and low-dose steroids in selected patients.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）的主要严重表现形式。由于该疾病的临床异质性，LN的治疗方法高度多样化。在此，我们报告一名28岁的白种女性，经活检证实为III级和V级难治性活动性LN，在就诊前约六年被诊断出，她通过贝利尤单抗和voclosporin成功得到治疗。她的实验室检查结果显示高滴度抗双链DNA抗体（>300）、补体水平低，尽管正在接受霉酚酸酯（MMF）和低剂量泼尼松治疗，但蛋白尿仍在增加。该患者符合SLE的欧洲抗风湿病联盟/美国风湿病学会（EULAR/ACR）分类标准，得分为28分，反映出有明显的全身性疾病累及。该患者耐受voclosporin和贝利尤单抗联合治疗九个月。在此期间，她未报告任何特定的副作用，根据2000年系统性红斑狼疮疾病活动指数（SLEDAI - 2K），处于临床缓解期，无全身性病情复发迹象。该病例凸显了在特定患者中联合使用贝利尤单抗、voclosporin、霉酚酸酯（MMF）和低剂量类固醇的潜力。
