Case report: successful treatment of membranous lupus nephritis with belimumab in an African female immigrant.

We describe the case of a 26-year-old African female who was treated successfully with belimumab in a case of severe membranous lupus nephritis and retinal vasculitis, resistant to first line therapy. She presented initially with chronic dacryoadenitis and screening showed nephrotic-range proteinuria. Biopsy of the kidney confirmed the diagnosis of membranous lupus nephritis. Clinical features (joint pain, dacryoadenitis, retinal vasculitis and lupus nephritis) in combination with serology (positive anti-double-stranded DNA (ds-DNA) antibodies, hypocomplementemia) confirmed the diagnosis of systemic lupus erythematosus (SLE). Treatment was immediately initiated with glucocorticosteroids (GCS), mycophenolate mofetil (MMF) and hydroxychloroquine sulphate (Plaquenil®). Tacrolimus was associated but no effect was observed with the proteinuria remaining in the nephrotic range and secondary effects of the glucocorticosteroids becoming a real concern. The patient was started on add-on belimumab with quasi-immediate effect on the proteinuria, making it possible to decrease the dosage of the other immunosuppressants and gradually stop them, even the GCS. The patient is currently in complete remission after 3 years of treatment with belimumab. We were able to stop immunosuppressive treatment but will keep her on antimalarial treatment as the most recent guidelines in treatment of SLE recommend.

Comparison of different routes of administration of nadroparin in hemodialysis.

AIM: In an open, crossover, randomized study in hemodialysis patients, we investigated possible differences of the effect of the low molecular weight heparin (LMWH) nadroparin/fraxiparine in relation to the route of administration. PATIENTS AND METHODS: The effect of nadroparin, administered by the venous line or by the arterial line after priming of the extracorporeal circuit with a part of the total dose administered, was compared with administration of the same dose by the arterial line as recommended by the manufacturer. Twelve stable, chronic hemodialysis patients were studied during 3 dialysis sessions for each treatment option. Concomitant medication was kept constant. RESULTS: Results obtained after administration of nadroparin by the venous line were comparable to those obtained after administration by the arterial line. When a part of the dose was added to the priming solution, the anti-Xa activity, measured after 2 hours of dialysis, was somewhat lower (p = 0.09). There was also a tendency towards longer manual compression time in this group. There was no difference in hemoglobin, serum urea and creatinine before the study and at the end of each treatment option. CONCLUSION: We therefore conclude that the safety and efficacy of administration of LMWH by the arterial and by the venous route are identical. There is no need for addition of a small dose of LMWH to the priming fluid.

Sex hormones, body fat distribution, resting metabolic rate and glucose-induced thermogenesis in premenopausal obese women.

The topographic specificity of upper body obesity is known to be at the origin of a series of metabolic complications. In contrast to this negative effect, women with abdominal obesity usually can lose more body weight than women with gluteal-femoral obesity. In order to find some contributive explanations for this effect, we studied resting metabolic rate (RMR) and glucose-induced thermogenesis (GIT) in both types of obesity. Since upper body obesity is characterized by androgen excess, a relationship between body fat distribution, sex hormones, RMR and indices of thermogenesis was studied. Of 39 obese women who were recruited (mean age: 32.4 +/- 9.3 years), 30 were compared for analysis. Upper body obesity (waist-to-hip ratio (WHR): 0.84 +/- 0.02; body mass index (BMI) 36.2: 36.2 +/- 6.0) is not characterized by differences in RMR, whereas glucose-induced thermogenesis is significantly higher in this subgroup (P < 0.008), expressed as percentage increase above RMR (18.3 +/- 8.5 vs. 11.9 +/- 3.6%) or as percentage of metabolisable energy intake (8.2 +/- 3.3 vs. 5.8 +/- 2.3%). Correlation coefficient data show that GIT determinants are closely related to WHR (r = 0.43; P < 0.01) and not to BMI. Resting metabolic rate, both in absolute terms and corrected for fat-free mass (FFM), is not related to indices of androgenicity, but is negatively related to serum oestradiol levels; this negative relationship with oestradiol disappears when RMR is corrected for both fat mass (FM) and FFM. GIT parameters are not related to free testosterone or oestradiol, regardless of the phase of the menstrual cycle.(ABSTRACT TRUNCATED AT 250 WORDS)