Radical improvement of signs and symptoms in systemic lupus erythematosus when treated with hemodiafiltration with endogenous reinfusion dialysis

Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE). In the kidney immune complexes (ICs) and autoantibodies activate mesangial cells that secrete the cytokines that further amplify inflammatory processes. We present a case of a 42-year-old woman presented Lupus Nephritis, with periods of exacerbation of SLE, with necrotic-like skin lesions, psoriatic arthritis without skin psoriasis, purpura to lower limb, petechial rash, joint pain, fever, eyelid edema with bilateral conjunctival hyperemia and itching When she was subjected to Hemodiafiltration with Endogenous Reinfusion (HFR) dialysis treatment with super high flux membrane Synclear 02 (SUPRA treatment), fever and joint pain was reduced immediately, subsequently all of her skin damages are reduced and she gradually decreased quantity of prednisone and immunosuppressor per die until completely suspend. As well known that SUPRA treatment remove cytokine from blood ; moreover was used the High-performance liquid chromatography coupled with Quadrupole Time-of-flight Mass Spectrometer (HPLC-QTOF-MS) for identification of proteins captured by resin bed during a dialysis session of the patient. With this technique was identified several biomarker of kidney injuries, uremic toxins, fragments of Immunoglobulins, antigen involved in anti-phospholipid syndrome and a new marker (α-defensin) that correlate significantly with disease activity. The removal of these different proteins can explain the improvement in the patient’s symptoms and the normalization of her LES, confirming that SUPRA are a suitable technique for LN treatment.