Lupus Erythematosus oo nidaamsan (SLE)-02

Bukaanku waa haweeney 20 jir ah oo qabta lupus erythematosus oo si daran oo degdeg ah u koraya. Iyadoo lagu daweeyay hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, iyo belimumab, shaqadeeda kelyaha ayaa xumaatay shan bilood gudahood, taasoo keentay nephritis daran oo leh proteinuria (qiimaha creatinine 24-saacadood ah oo gaaraya 10,717 mg/g) iyo hematuria yar yar. Afartii toddobaad ee xigay, heerkeeda creatinine wuxuu kordhay 1.69 mg/dl (caadi ahaan 0.41 ~ 0.81 mg/dl), oo ay weheliso hyperphosphatemia iyo renal tubular acidosis. Baaritaanka kelyaha ayaa muujiyay heerka 4aad ee lupus nephritis. Tusmada dhaqdhaqaaqa NIH ee wax laga beddelay waxay ahayd 15 (ugu badnaan 24), tusmada NIH ee wax laga beddelayna waxay ahayd 1 (ugu badnaan 12). Bukaanku wuxuu lahaa heerar dhammaystiran oo hoos u dhacay iyo dhowr antibody oo iskeed u shaqeeya oo jirkeeda ku jira, sida antibody-yada antinuclear-ka, DNA-da anti-double-stranded, anti-nucleosome, iyo anti-histone antibody.

Sagaal bilood ka dib, heerka creatinine-ka bukaanka ayaa kor u kacay ilaa 4.86 mg/dl, taasoo u baahan dialysis iyo daaweyn ka hortagta dhiigkarka. Natiijooyinka shaybaarka ayaa muujiyay dhibco ah Tusmada Waxqabadka Cudurka SLE (SLEDAI) oo ah 23, taasoo muujinaysa xaalad aad u daran. Sidaas darteed, bukaanku wuxuu maray daaweynta CAR-T. Habka daaweyntu wuxuu ahaa sidan soo socota:

- Hal toddobaad ka dib markii la geliyay unugyada CAR-T, muddada u dhaxaysa kalfadhiyada dialysis-ka ayaa kordhay.

- Saddex bilood ka dib markii la geliyay, heerka creatinine-ka ayaa hoos u dhacay ilaa 1.2 mg/dl, heerka shaandhaynta glomerular-ka ee la qiyaasay (eGFR) ayaa ka kordhay ugu yaraan 8 ml/min/1.73m² ilaa 24 ml/min/1.73m², taasoo muujinaysa cudurka kelyaha ee daba-dheeraada ee heerka 3b. Daawooyinka ka hortagga dhiigkarka ayaa sidoo kale la dhimay.

- Toddobo bilood ka dib, calaamadaha xanuunka kala-goysyada bukaanka ayaa yaraaday, walxaha dhammaystirka ah ee C3 iyo C4 ayaa caadi ku soo noqday lix toddobaad gudahood, unugyada difaaca jirka ee ka hortagga nukliyeerka, anti-dsDNA, iyo unugyada kale ee difaaca jirka ayaa baaba'ay. Shaqada kelyaha ee bukaanka ayaa si weyn u soo hagaagtay, iyadoo 24-saacadood oo borotiin ah ay hoos ugu dhacday 3400 mg, inkastoo ay sii korodhay dabagalkii ugu dambeeyay, taasoo soo jeedinaysa waxyeello aan laga bogsan karin oo glomerular ah. Fiirsashada albumin-ka plasma-ga ayaa caadi ahayd, iyada oo aan lahayn barar; falanqaynta kaadida ma muujin wax calaamado ah oo ku saabsan nephritis, mana jirin hematuria ama unugyada dhiigga cas. Bukaanku hadda wuxuu dib u bilaabay nolol caadi ah.