MO325YOU CAN BE DIAGNOSED AND CURED FOR LUPUS CYSTITIS AND LUPUS PODOCYTOPATHY DESPITE BEING A POOR, VILLAGE TEENAGE GIRL IN ALBANIA
Authors: Likaj Erjola , Barbullushi Myftar , Shehaj Larisa 
Published: May 2021

Abstract

Background and Aims
We present the case of a 16 years old girl who was admitted to our Emergency Unit in May 2019 for diarrhea, nausea, dysuria, foamy urine, urinary incontinence, malnutrition, polyserositis, and hypertension. Her medical history started 8 months ago with diarrhea and urinary incontinence for which first was hospitalized in the Gastroenterology unit and then in the Infectious Disease Unit. There she was completed with colonoscopy, contrast CT scan and then was discharged with the diagnosis of Gastrocolitis. In January 2019 due to the persistence of symptoms they did a specialized consultation in Athens, Greece. After a series of examinations the patient was diagnosed with Anorexia Nervosa and antidepressant therapy was started. In February 2019, the patient was rehospitalized with nephritic grade proteinuria and the kidney ultrasound showed stage four bilateral hydronephrosis and urinary bladder with thick and trabecular walls. To exclude urological problems, an MRI was performed which results in no obstructive problems. Arterial hypertension and lower extremities edema were present. She was then transferred to our University Hospital “Mother Teresa”, Nephrology Department for further examinations. During hospitalization her blood investigation showed severe anemia (HGB = 6.7gr / dl), kidney failure (creatinine = 1.5mg / dl, urea = 83mg / dl), elevated liver enzymes (Alt:162u/ml, Ast:101u/ml), albuminemia: 2.9 g / dl, total proteinemia: 5.9g / dl. The lipid profile showed cholesterolemia: 300mg / dl, triglyceridemia: 170mg / dl. Electrolytes were within normal limits. Coombs test resulted positive. Urinalysis showed microscopic hematuria with leukocyturia and grave albuminuria around16gr/ 24 hours. Immunologic workup showed: AntiDna = 383.5U / ml, Ena profile SSA poz, ANA ++++, C3 101, C4 18. Tumoral markers and hepatitis resulted in negativ.

Method
Renal biopsy was performed which resulted: Lupus Podocytopathy

Results
The patient was diagnosed with a case of lupus cystitis with lupus podocytopathy. She was treated with methylprednisolone, immunosuppressive therapy, and Plaquenil. It was started with intravenous methylprednisolone 0.5 g / day for 3 days and then switched to oral methylprednisolone 0.5 mg /kg /day. Mycophenolate mofetil was started with 1 gr increased to 2 grams. After 6 months of therapy Hydroureteronephrosis completely disappeared and 24 h urinary protein became normal. The dose of therapy was tapered and switch to maintenance doses, methylprednisolone 8 mg, MMF 500gr, and Plaquenil. Laboratory examinations Hgb: 12gr / dl, Urea: 36mg / dl, Creatine: 0.6mg / dl, Alt: 23u / l, Ast: 26u / l. Urinalysis: albumin trace, RBC: 0, Wbc 8 / field. The autoimmune workup was normalized, AntiDna; C3, C4, Ana. In a realized ultrasound hydronephrosis was gone, kidney structure was in normal parameters and bladder wall was in a normal structure.

Conclusion
Disseminated Eritematous Lupus and its rare forms like Lupus Cystitis and Lupus Podocytopathies can be diagnosed, cured successfully, and followed up in the best way despite you are a simple teenager in a village of Albania or a noticed and famous actor or singer in the USA.