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15 Management of lupus nephritis
  1. Richard Furie
  1. Zucker School of Medicine at Hofstra/Northwell, New York, USA


Case 1: A 22-yeaar-old male with headache, confusion and fever A 22-year-old male was admitted to the hospital because of headache, confusion and fever. He had been previously well. At the time of admission, he was on no medications. Initial laboratory test results were notable for: WBC 2,800; Hb: 6.7; Platelets: 64,000; Creatinine: 1.9. The patient was given broad spectrum antibiotics for the treatment of sepsis and/or bacterial meningitis. However, the patient’s mental status worsened, and he became comatose. All cultures were sterile. A ‘shotgun’ diagnostic approach revealed: ANA: 1/2560 (H); DNA: 883 IU/dL. The creatinine continued to rise.

The impression was that of systemic lupus erythematosus complicated by anaemia, thrombocytopenia, nephropathy and CNS disease. ‘Pulse’ steroids were administered for 3 days without subsequent improvement. Intravenous gamma-globulin failed to raise the platelet count. Rheumatology to the rescue!


  1. Symmers WS. Thrombotic microangiopathic haemolytic anaemia (thrombotic microangiopathy). Br Med J 1952 Oct 25;2(4790):897–903.

  2. Jain R, et al. Systemic lupus erythematosus complicated by thrombotic microangiopathy. Semin Arthritis Rheum 1994;24(3):173–182.

  3. Park MH, et al. Complement-mediated thrombotic microangiopathy associated with lupus nephritis. Blood Advances Aug 2018;2(16):2090–2094.

  4. Kello N, et al. Secondary thrombotic microangiopathy in systemic lupus erythematosus and antiphospholipid syndrome, the role of complement and use of eculizumab: case series and review of literature. Semin Arthritis Rheum 2018 Dec 4. pii: S0049-0172(18)30493-1.

  5. George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med 2014;371:654–666.

  6. Chatzikonstantinou T, et al. An Update in Drug-Induced Thrombotic Microangiopathy. Front Med (Lausanne). 2020 May 22;7:212.

  7. Palma LMP, et al. Complement in Secondary Thrombotic Microangiopathy. Kidney Int Rep 2021;6:11–23.

Learning Objectives

  • Describe the clinical presentation of thrombotic microangiopathy (TMA)

  • Discuss treatment options of TMA

  • Review proposed modifications to the classification of lupus nephritis

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