Dramatic effects of eculizumab in a child with diffuse proliferative lupus nephritis resistant to conventional therapy

Rosanna Coppo, Licia Peruzzi, Alessandro Amore, Silvana Martino, Luca Vergano, Inna Lastauka, Arrigo Schieppati, Marina Noris, Pier Angelo Tovo, Giuseppe Remuzzi

Research output: Contribution to journalArticlepeer-review

Abstract

Case: A 4 year-old girl, whose parents were first-grade cousins of Moroccan ancestry, developed SLE that progressed to severe renal involvement despite standard therapy. She had persistently undetectable serum C4 levels and very low C3 levels (1:640) that remained unmodified during 2 years of follow-up. No mutations of genes encoding for complement inhibitors were detected. Despite aggressive therapy based on prednisone, plasma exchanges, and cyclosporine, the child worsened and eventually developed features of atypical hemolytic uremic syndrome (aHUS). Treatment with eculizumab provided prompt remission of vasculitis, proteinuria, and hematuria, with normalization of renal function. Two attempts to withdraw eculizumab were followed by severe relapses and rescued by reinstating treatment. The child has been treated with eculizumab for > 17 months without relevant side effects.

Conclusion: C5 inhibition by eculizumab completely reversed clinical symptoms and laboratory renal signs of severe lupus nephritis. Blocking complement-system activation with the use of targeted drugs may be a new and exciting strategy to treat SLE patients unresponsive to conventional therapy.

Background: Treatment of systemic lupus erythematosus (SLE) with severe diffuse proliferative nephritis is often challenging, particularly in small children in whom a genetic conditioning is likely to play a role. The effectiveness of standard therapy based on glucocorticoid and immunosuppressive drugs is often unsatisfactory.

Original languageEnglish
Pages (from-to)167-172
Number of pages6
JournalPediatric Nephrology
Volume30
Issue number1
DOIs
Publication statusPublished - 2015

Keywords

  • Atypical hemolytic uremic syndrome
  • C5 inhibition
  • Eculizumab
  • Lupus nephritis
  • Systemic lupus erythematosus
  • Treatment
  • Treatment-resistant SLE

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

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