Systemic Lupus Erythematosus dengan Nefritis

NOVIYANI LEKSOMONO, dr. Sumadiono, Sp.AK; dr.Retno Palupi, M.Sc, Sp.A

2017 | Tesis-Spesialis | SP ILMU KESEHATAN ANAK

Nefritis lupus (NL) merupakan manifestasi terbanyak lupus eritematosus sistemik (LES) berat dengan morbiditas dan mortalitas yang tinggi akibat perburukan fungsi ginjal maupun akibat penggunaan obat imunosupresif dalam tata laksananya. Nefritis lupus pada anak menampilkan aktivitas dan progresivitas penyakit yang umumnya lebih berat daripada dewasa. Pada laporan kasus ini dilaporkan anak perempuan 15 tahun dengan nefritis lupus dan manifestasi lain seperti anemia berat, serositis, dan edem anasarka mulai dari diagnosis, tata laksana awal, dan pemeliharaan sampai berhasil remisi pada bulan ke-10 terapi dengan rejimen lupus berat. Selama pengobatan tidak didapati flare, pasien memiliki kepatuhan yang baik sehingga diharapkan remisi dapat dipertahankan sampai masuk usia dewasa. Pada pasien didapati efek samping terapi imunosupresif berupa amenore sekunder dan efek samping steroid berupa osteopenia meskipun telah diberikan terapi pencegahan.

Lupus nephritis (LN) is the most common clinical manifestation of severe systemic lupus erythematosus (SLE). It has severe morbidity and high mortality due to deterioration of renal function and adverse effects of chemotherapy agent as a part of its management. Juvenile lupus nephritis shows high disease activity and progressivity than adult lupus nephritis. Here, we report a 15 year old girl with lupus nephritis accompanied by severe anemia, serositis, and generalized edema. We report comphrehensively started from establishing the diagnosis, early management, maintenance therapy, until she succed reach remission state on the 10th month of severe SLE protocol. During the treatment, we did not find flare condition due to her good compliance and family support. Based on this result, maintaining remission until adult age is the main purpose of the next management. Adverse effects of imunotherapy agent that experienced by the patient were secondary amenorrhea and osteopenia after longterm steroid administration aside from preventive treatment.

Kata Kunci : nefritis lupus, lupus eritematosus sistemik/lupus nephritis, systemic lupus erythematosus