Indwara ya Systemic Lupus Erythematosus (SLE)-02

Uyu murwayi ni umugore w'imyaka 20 ufite indwara ikomeye kandi igenda yihuta ya lupus erythematosus (SLE). Nubwo yavuwe na hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, na belimumab, imikorere ye y'impyiko yarushijeho kwangirika mu mezi atanu, bituma agira nephritis ikomeye hamwe na proteinuria (agaciro ka creatinine mu masaha 24 kagera kuri 10.717 mg/g) na microscopic hematuria. Mu byumweru bine byakurikiyeho, urugero rwe rwa creatinine rwiyongereye rugera kuri 1.69 mg/dl (urugero rusanzwe 0.41 ~ 0.81 mg/dl), ruherekejwe na hyperphosphatemia na renal tubular acidosis. Isuzuma ry'impyiko ryagaragaje ko yanduye lupus nephritis yo mu cyiciro cya 4. Igipimo cy'ibikorwa bya NIH cyahinduwe cyari 15 (ntarengwa 24), naho igipimo cy'ibihe bya NIH cyahinduwe cyari 1 (ntarengwa 12). Umurwayi yari afite ingano y’inyongera yagabanutse kandi afite uturemangingo twinshi mu mubiri we, nk’uturemangingo tw’umubiri turwanya imisemburo, ADN irwanya imitsi ibiri, anti-nucleosome, na anti-histone.

Nyuma y'amezi icyenda, urugero rwa creatinine rw'umurwayi rwazamutse rugera kuri 4.86 mg/dl, bisaba dialyse no kuvura umuvuduko ukabije w'amaraso. Ibisubizo bya laboratwari byagaragaje amanota 23 ya SLE Disease Activity Index (SLEDAI), bigaragaza ko yari afite indwara ikomeye cyane. Kubera iyo mpamvu, umurwayi yakorewe CAR-T therapy. Uburyo bwo kuvura bwari ubu bukurikira:

- Nyuma y'icyumweru kimwe nyuma yo guhabwa selile za CAR-T, igihe cyo gukoresha dialyse cyariyongereye.

- Amezi atatu nyuma yo guterwa, urugero rwa creatinine rwagabanutse rugera kuri 1.2 mg/dl, kandi igipimo cyagenwe cyo kuyungurura glomerular (eGFR) cyariyongereye kiva kuri 8 ml/min/1.73m² kigera kuri 24 ml/min/1.73m², bigaragaza ko indwara y’impyiko idakira mu cyiciro cya 3b. Imiti igabanya umuvuduko ukabije w’amaraso nayo yaragabanutse.

- Nyuma y'amezi arindwi, ibimenyetso by'uburwayi bw'imitsi y'umurwayi byaragabanutse, ibintu byuzuzanya C3 na C4 byongeye kumera neza mu byumweru bitandatu, kandi abasirikare barinda imyuka ya kirimbuzi, anti-dsDNA, n'izindi antibody zigenda zihagarara. Imikorere y'impyiko y'umurwayi yarushijeho kuba myiza cyane, aho poroteyine mu masaha 24 yagabanutse igera kuri 3400 mg, nubwo yakomeje kwiyongera mu isuzuma rya nyuma, bigaragaza ko hari ibyangiritse bidasubirwaho mu mikorere y'amaraso. Igipimo cya albumin mu maraso cyari gisanzwe, nta kubyimba; isuzuma ry'inkari nta bimenyetso bya nephritis ryagaragaje, kandi nta maraso cyangwa se imisemburo itukura yagaragaye. Ubu umurwayi yongeye kugira ubuzima busanzwe.