Systemic Lupus Erythematosus (SLE)-02

The patient is a 20-year-old female with severe and rapidly progressing systemic lupus erythematosus (SLE). Despite treatment with hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, and belimumab, her renal function deteriorated within five months, leading to severe nephritis with proteinuria (24-hour creatinine value reaching 10,717 mg/g) and microscopic hematuria. Over the next four weeks, her creatinine level increased to 1.69 mg/dl (normal range 0.41~0.81 mg/dl), accompanied by hyperphosphatemia and renal tubular acidosis. A renal biopsy indicated stage 4 lupus nephritis. The modified NIH activity index was 15 (maximum 24), and the modified NIH chronicity index was 1 (maximum 12). The patient had decreased complement levels and multiple autoantibodies in her body, such as antinuclear antibodies, anti-double-stranded DNA, anti-nucleosome, and anti-histone antibodies.

Nine months later, the patient's creatinine level rose to 4.86 mg/dl, requiring dialysis and antihypertensive therapy. Laboratory results showed a SLE Disease Activity Index (SLEDAI) score of 23, indicating a very severe condition. Consequently, the patient underwent CAR-T therapy. The treatment process was as follows:

- One week after CAR-T cell infusion, the intervals between dialysis sessions increased.

- Three months post-infusion, the creatinine level decreased to 1.2 mg/dl, and the estimated glomerular filtration rate (eGFR) increased from a minimum of 8 ml/min/1.73m² to 24 ml/min/1.73m², indicating stage 3b chronic kidney disease. Antihypertensive medications were also reduced.

- After seven months, the patient's arthritis symptoms subsided, complement factors C3 and C4 returned to normal within six weeks, and antinuclear antibodies, anti-dsDNA, and other autoantibodies disappeared. The patient's renal function improved significantly, with 24-hour proteinuria decreasing to 3400 mg, although it remained elevated at the last follow-up, suggesting some irreversible glomerular damage. The plasma albumin concentration was normal, with no edema; urine analysis showed no signs of nephritis, and there was no hematuria or red blood cell casts. The patient has now resumed a normal life.