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Old 06-11-2012
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ObGyn Is this lupus nephritis or severe pre-eclampsia?

A 24-year-old woman with a history of SLE presents to your office in the seventh month of her first pregnancy. She has been having intermittent episodes of headaches associated with some nausea and vomiting over the past week. Her lupus has been well controlled on low-dose prednisone. Her normal blood pressure is 125/80 mm Hg. Her urinalysis and creatinine concentrations were normal at the last visit. Anti-Ro, anti-La, and antiphospholipid antibodies were negative at the onset of her pregnancy. Today her blood pressure is 135/85 mm Hg, with a pulse of 80/min. Her physical examination and fetal monitoring is unremarkable. Today's urinalysis shows proteinuria, erythrocytes, and erythrocyte casts. Her creatinine is 1.7 mg/dL. The complete blood count and liver function tests are normal. Complement levels show low levels of C3 and C4.

What would be most appropriate as the next best mode of therapy?

(A) Bedrest
(B) Magnesium sulfate
(C) Cyclophosphamide
(D) Azathioprine
(E) Emergent cesarean section
(F) Methotrexate
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-this is most likely lupus nephritis=protinurea+rbcs+cast+low complement
-in preeclamsia=only protinure(no rbcs or cast)+coplement may be high or normal
*ans(A)
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A........???
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(D) Azathioprine
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Quote:
Originally Posted by um aala View Post
-this is most likely lupus nephritis=protinurea+rbcs+cast+low complement
-in preeclamsia=only protinure(no rbcs or cast)+coplement may be high or normal
*ans(A)
How can you not treat Lupus nephritis?

Ideally you should do a biopsy to confirm the diagnosis and increase the dose of prednisone but since those are not among the choices Azathioprine seems to be the right answer.
Other option is to deliver the baby but Emergent cesarean section is not needed and if needed (patient's condition worsen) then the baby can be delivered vaginally after giving steroids for lung maturity since the pregnancy is in the 7 th month.
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Quote:
Originally Posted by Novobiocin View Post
How can you not treat Lupus nephritis?

Ideally you should do a biopsy to confirm the diagnosis and increase the dose of prednisone but since those are not among the choices Azathioprine seems to be the right answer.
Other option is to deliver the baby but Emergent cesarean section is not needed and if needed (patient's condition worsen) then the baby can be delivered vaginally after giving steroids for lung maturity since the pregnancy is in the 7 th month.
-yes may be ur right ,although the rx of ln arange from non spasific measure to cytotoxic drugs which it CI in pregnancy .am not sure.
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Quote:
Originally Posted by Novobiocin View Post
How can you not treat Lupus nephritis?

Ideally you should do a biopsy to confirm the diagnosis and increase the dose of prednisone but since those are not among the choices Azathioprine seems to be the right answer.
Other option is to deliver the baby but Emergent cesarean section is not needed and if needed (patient's condition worsen) then the baby can be delivered vaginally after giving steroids for lung maturity since the pregnancy is in the 7 th month.
You are correct buddy , Its Azathioprine .........

cyclophosphamide is CI in pregnant woman .......

http://ndt.oxfordjournals.org/content/21/2/268.full
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