[Renaliste] Probable nephropathie lupique: Traitement sans histologie rénale?

[A. Zannier, MD, MSc]

Chers Amis,

Voici un cas qui me turlupine depuis la semaine dernière (cf. infra). 

“Excuse my English” car, en pleine consultation, je fais un copié/collé 
du message envoyé a Nephrol. Merci de vos opinions,

Bien amicalement,

Alfredo

A. Zannier, MD, MSc

___

Dear Nephrolnauts,
 
I have been recently referred a 63 y.o. male with an old history of anti-phospholipid syndrome (multiple episodes of CNS thrombosis/emboli, mnemonic and mood modifications, on anti-vitamin K treatment for years),  because of recent appearance of anti-nuclear and anti-native DNA antibodies.
 
Further tests revealed low C3, C4 and CH50, positive anti-cardiolipin Abs, renal failure (CrCl 47 ml/mn), proteinuria (2.4 g/d), leucocyturia and hematuria. Physical showed altered vision fields and HTN.
 
Since this picture was compatible with SLE and lupus nephropathy, coumadinic treatment was replaced by Calciparin and a renal Bx was scheduled. Coagulation tests, however, were abnormal on the biopsy’s day and 24 H later. Given the hemorragic risks, I didn’t perform the (blind) Bx and asked a surgeon to do it coelioscopically instead. But the anesthesist contraindicated the biopsy because of the abnormal coagulation test (he maintain his position after further discussion).
 
Now, what would you do?
 
1. Look for another surgeon + anesthesist (I’m doing so).
2. Treat the patient without a renal Bx (I am inclined to do so if 1 fail).
3. Comments?
 
Thanks for your inputs. Best regards,
 
Alfredo
 
A. Zannier, MD, MSc






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