1.

Problem identification
1.1 SLE ACR 2005

1. Malar rash
2. Arthritis
3. Renal disorder proteinuria 4+, RBC cast, HTN

(BP 155/95 mmHg),

4. Hematologic disorder Hb< 10g/dl (9.4 g/dl)
5. Immunologic disorder Anti-ds DNA antibody
Antiphospholipid antibody (+)
6. Antinuclear antibody (ANA) ANA titer 1:40 (1:320)
(+)
4 11

SLE
1.2
lupus nephritis

-
-
-

- BUN 35 mg/dl ( ) , Scr 2.1 mg/dl ( baseline 0.8
mg/dl)

- urinalysis RBC cast Protein dip

strip > 3+ (4+)
- urine 24 hr > 0.5 g/d (4.2
g/d)
- renal biopsy involve 40% of all glomeruli
(focal LN <50% of glomeruli class III )

2. Desired outcome
2.1


SLE

(pneumonia)

2.2


lupus nephritis

ESRD
3. Optimal treatment plan
3.1 lupus nephritis

induction phase

maintenance phase
class III LN ISN/RPS 2003
Focal LN < 50% of glomeruli severe LN
ACR 2012
- Induction phase ( 6 )
IV Mycophenolate mofetil 3 g/day 6 (

cyclophosphamide
)

IV Methylprednisolone 1 g OD 3
prednisolone
1 mg/kg/d (52 mg/d)
- Maintenance phase ( 6 )
Mycophenolate 2 g/day 6

3.2
(SLE complications)

(maintenance remission)
1. Antimalarial drug chloroquin
hydroxychloroquin

homocysteine
homocysteine

2. Dapsone
3. ACEIs ARBs

proteinuria

4. Azathioprine Mycophenolate

4. Outcome evaluation
4.1

, , ,

BUN, Scr, Urinalysis, Hematology

1. Mycophenolate : Leukopenia , Thrombocytopenia , anemia,

nausea, diarrhea CBC

2 g/d
3-4
2. Methylprednisolone : GI ulcer, osteoporosis, myopathy,
hyperglycemia


omeprazole

5. Patient education
5.1

SLE

1.

2. 10.00-16.00
SPF
30
3.

4.

5.

6



estrogen
6.
corticosteroid
7.

8.