Reactivation of Systemic Lupus in three Patients Undergoing CAPD

Abstract

Generally patients with end-stage renal disease (ESRD) due to lupus nephritis, have minimal extrarenal disease activity <Juring hemodialysis. This may be related to immunological changes secondary to chronic renal failure or the dialysis procedure itself, or both. This paper describes three patients with lupus nephritis undergoing continuous ambulatory peritoneal dialysis (CAPD) in whom we observed reactivation of SLE, by both clinical and serological criteria. This may suggest that in patients undergoing CAPD the immune system is more nearly intact than in hemodialysis. These cases should heighten awareness that patients may suffer flare-ups of SLE during CAPD even long after the onset of renal failure.

Autoantibodies and Other Autoimmune Serologic Abnormalities in Dialysis Patients

“…Significant decrease in ANA titer can be expected within two months of initiation of hemodialysis; in most patients, titers decrease to 1:80 or less and serum complement (C3) levels return to normal (16). Flares of systemic lupus erythematosus (SLE) in chronically dialyzed patients may involve multiple organ systems and be associated with serologic abnormalities (17)(18)(19)(20). These studies confirm that dialysis patients experience less severe extra-renal manifestations, a decreased need for immunosuppressive medications and a significantly decreased anti-double stranded DNA (anti-dsDNA) levels.…”

Exacerbation of Extrarenal Systemic Lupus Erythematosus following Peritonitis in Peritoneal Dialysis

“…The activity of systemic lupus erythematosus (SLE) in patients on peritoneal dialysis (PD) has been reported to decrease (1), remain high (2,3), or increase (4). Lupus patients have an increased risk of PD-related infections (5).…”

“…The temporal association between an episode of peritonitis and a lupus flare suggests that the infection could have triggered the flare. In a literature search, we found one other case of lupus flare following PD catheter infection in the series by Wu and colleagues (4). These authors did not comment on the probability that the PD catheter infection triggered the lupus flare.…”