Refractory Lupus Nephritis in a Woman With Systemic Lupus Erythematosus on Immunosuppressive Therapy: A Case Report

Systemic lupus erythematosus (SLE) is a multisystem rheumatologic condition that can affect nearly every organ. Recognition of lupus nephritis, a subset of SLE, is critical to preserve organ function. In this case report, we highlight a case of combined class III and V lupus nephritis in a young woman with SLE who subsequently progressed to chronic kidney disease (CKD) stage IIIb while on treatment with immunosuppressants, despite adequate medication compliance. A 24-year-old African American woman with a history of SLE presented to our hospital with severe nephrotic-range proteinuria and new-onset lower extremity edema. She had refractory lupus, as evidenced by persistent proteinuria despite six months of immunosuppressive therapy. She was treated initially with steroids and azathioprine; however, over time her lupus flared and her kidney function worsened despite treatment with mycophenolate, steroids, and eventually voclosporin. To date, she has had several lupus flares while on treatment and appears to have progressed toward CKD stage IIIb.