Nidaamka Lupus Erythematosus (SLE) -02

Bukaanku waa gabadh 20 jir ah oo leh lupus erythematosus (SLE) oo aad u daran oo degdeg ah. In kasta oo lagu daaweeyay hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, iyo belimumab, shaqadeeda kelyaha ayaa xumaatay shan bilood gudahood, taasoo keentay nephritis daran oo leh borotiinka (qiimaha creatinine 24-saac gaadhaya 10,717 mg/g) iyo hematuria microscopic. Afarta toddobaad ee soo socota, heerka creatinine-ka ayaa kordhay ilaa 1.69 mg/dl (kala duwanaanshaha caadiga ah 0.41 ~ 0.81 mg/dl), oo ay la socdaan hyperphosphatemia iyo tubbada acidosis ee kelyaha. Ka-qaadista kelyaha ayaa muujisay heerka 4 lupus nephritis. Tusaha waxqabadka NIH ee wax laga beddelay wuxuu ahaa 15 (ugu badnaan 24), iyo NIH chronicity index oo la beddelay wuxuu ahaa 1 (ugu badnaan 12). Bukaanku wuxuu hoos u dhacay heerarka dhamaystirka iyo dhowr autoantibodies ee jirkeeda, sida unugyada difaaca nukliyeerka, anti-double-stranded DNA, anti-nucleosome, iyo anti-histone antibodies.

Sagaal bilood ka dib, heerka creatinine ee bukaanku wuxuu kor u kacay 4.86 mg/dl, wuxuu u baahan yahay sifeynta iyo daaweynta dhiig-karka. Natiijooyinka shaybaadhku waxay muujiyeen buundada SLE Disease Activity Index (SLEDAI) ee 23, taasoo muujinaysa xaalad aad u daran. Sidaa awgeed, bukaanku waxa uu maray daawaynta CAR-T. Habka daawaynta ayaa ahayd sida soo socota:

- Hal usbuuc ka dib faleebo unug CAR-T, u dhexeeya kalfadhiyada sifaynta ayaa kordhay.

- Saddex bilood ka dib faleebo, heerka creatinine wuxuu hoos u dhacay ilaa 1.2 mg/dl, iyo qiyaasta sifaynta glomerular (eGFR) ayaa kordhay ugu yaraan 8 ml/min/1.73m² ilaa 24 ml/min/1.73m², taasoo muujinaysa heerka 3b. cudur kelyo joogto ah. Daawooyinka ka hortagga hypertension sidoo kale waa la dhimay.

- Toddoba bilood ka dib, calaamadaha arthritis-ka ee bukaanka ayaa hoos u dhacay, qodobbada dhamaystiraya C3 iyo C4 ayaa caadi ku soo noqday lix toddobaad gudahood, iyo unugyada difaaca nukliyeerka, anti-dsDNA, iyo unugyada kale ee autoantibodies ayaa la waayay. Shaqada kelyaha ee bukaan-socodka ayaa si weyn u wanaajisay, iyadoo 24-saac proteinuria ay hoos u dhacday 3400 mg, inkastoo ay sare u kacday dabagalkii ugu dambeeyay, taas oo soo jeedinaysa qaar ka mid ah waxyeellada glomerular-ka ah ee aan la bedeli karin. Xoojinta albumin-ka balaasmaha waxay ahayd mid caadi ah, oo aan lahayn barar; Falanqaynta kaadida ma muujin calaamado nephritis, mana jirin hematuria ama unugyada dhiigga cas cas. Bukaanku hadda waxa uu dib u bilaabay nolol caadi ah.