Background and aims Systemic lupus represents a major autoimmiune disorder that leads to different major injuries to different organs of the body. Lupus nephritis can present with different disorders like nephrotic syndrome, acute kidney injury and rapidly progressive glomerulonephritis. Wise and tailored management of these cases is a must for nephrologists in order to gain the complete remission with the least side effects. If lupus nephritis is associated with other organs problems like heart failure, prosthetic valves and oral warfarin therapy, it needs more wise management. We clarify the tailored management of lupus nephritis induced nephrotic syndrome and acute kidney injury meanwhile the patient on oral warfarin therapy for prosthetic valve replacement and subsequent heart failue.

Methods We report a case of heart failure with mitral and aortic valves replacement on oral warfarin therapy. She had nephrotic syndrome, AKI due to lupus nephritis. The patient recieved high dose of oral steroid and maintained on hemodialysis for 2 months with full recovery of the AKI and partial recovery of the nephrotic syndrome.

Results The patient recieved oral high dose steroid only. Partial remession of the nephrotic syndrome occured with full recovery of the acute kidney injury and she was maintained on once per week ultrafiltration session with improvement of the ejection fraction of the heart.

Conclusions Lupus nephritis can present with complex situations. Individualization and tailoring the management for every patient in order to gain complete remission represents a challenge for nephrologists.