Case of severe heart and kidney damage in a young man with systemic red lupus

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Abstract

Systemic autoimmune diseases remain a complex problem for specialists of different profiles. Despite some progress in their diagnosis and treatment, the incidence of these diseases is now steadily increasing. This is primarily due to polyorganic lesion, which requires a balanced approach to the choice of treatment of the patient, taking into account the functional condition of different organs and systems. Thus in particular systemic lupus erythematosus, which occupies a leading place in the structure of rheumatological pathology, often occurs with kidneys damage, cardiovascular system, hematological disorders. Most studies are based on the systemic lupus erythematosus in women, while the male sex is recognized as a factor of adverse outcomes and severe course of the disease. The article covers the peculiarities of the course of systemic lupus erythematosus in men, considered the variants of heart affection within the systemic process, and also presents a clinical case of systemic lupus erythematosus of high activity in a young man with terminal kidney affection, pancarditis with formation of severe mitral insufficiency, pancytopenia. The aspects of the management of a patient with severe valve disease of the heart in need of renal replacement therapy against the background of drug immunosuppression, the possibility of correction of valve disease. The combination of terminal renal failure and heart failure in a young man in the clinical case cited is an example of the multidiscplinar problem of treating systemic lupus erythematosus.

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About the authors

Eugene V. Timofeev

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: darrieux@mail.ru

MD, PhD, Associate Professor, Department of Propaedeutics Internal Medicine

Russian Federation, Saint Petersburg

Olga R. Golubeva

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: 12golubevaolga@gmail.com

Assistant Professor, Department of Propaedeutics Internal Medicine

Russian Federation, Saint Petersburg

Vladimir A. Isakov

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: vlisak@mail.ru

MD, PhD, Associate Professor, Head Department of Propaedeutics Internal Medicine

Russian Federation, Saint Petersburg

Elena V. Vyutrikh

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: 273evv6456@mail.ru

MD, PhD, Associate Professor, Department of Propaedeutics Internal Medicine

Russian Federation, Saint Petersburg

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2. Dynamics of clinical blood analysis of a patient with systemic lupus erythematosus against the background of pathogenetic therapy: a – leucocytes; b – thrombocytes; c – hemoglobin. The arrow indicates the start date of pathogenetic therapy (a)

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3. Dynamics of clinical blood analysis of a patient with systemic lupus erythematosus against the background of pathogenetic therapy: a – leucocytes; b – thrombocytes; c – hemoglobin. The arrow indicates the start date of pathogenetic therapy (b)

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4. Dynamics of clinical blood analysis of a patient with systemic lupus erythematosus against the background of pathogenetic therapy: a – leucocytes; b – thrombocytes; c – hemoglobin. The arrow indicates the start date of pathogenetic therapy (c)

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Copyright (c) 2020 Timofeev E.V., Golubeva O.R., Isakov V.A., Vyutrikh E.V.

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