Pediatric emergency medicine trisk 2939 2939

toes; pain,
swelling in digits

Ocular

Blurring or loss of
vision, headache

Funduscopic
examination
CT scan

Traverse
myelitis

Paraplegia,
CT, MRI, LP (once
paraparesis, pain,
epidural abscess
sensory level
excluded),
antiphospholipid
antibody, lupus
anticoagulant

analgesia,
prednisone
Calcium-channel
blockers
Sympathetic ganglion
block

Lumbar puncture
(caution), prednisone
Pulse dose
methylprednisolone,
cytotoxic agents,
anticoagulation

a Treatment

regimens (except for infectious category) assume that an infectious etiology has been excluded.
CBC, complete blood count; ESR, erythrocyte sedimentation rate; CSF, cerebrospinal fluid; BUN, blood urea
nitrogen; PO, orally; IV, intravenously; EEG, encephalogram; MRI, magnetic resonance imaging; CT, computed
tomography; ICU, intensive care unit; ANA, antinuclear antibody; NPO, nothing by mouth; NG, nasogastric; EKG,
electrocardiogram; NSAIDs, nonsteroidal anti-inflammatory drugs; LP, lumbar puncture.

Renal Complications. Renal disease is a major cause of morbidity in SLE, so it is
important to establish its presence and severity at the time of diagnosis, and to regularly
monitor renal function thereafter. Clinical manifestations of lupus nephritis are often
minimal. Signs of nephrotic syndrome or acute renal failure require a more thorough
investigation that should include estimation of the protein in a 24-hour urine collection;
creatinine clearance; measurement of C3, ANA, and anti-ds DNA antibodies; and renal
biopsy. In a patient with SLE and documented renal disease, hospitalization is
necessary in the presence of rapidly worsening renal status, hypertensive crisis, or
severe complications of therapy.
Treatment is aimed at preserving renal function while minimizing medication
toxicity. Selection of therapeutic agents depends on biopsy results and classification of
renal involvement according to the World Health Organization classification, available
at .
Active disease often may be managed with pharmacologic doses of corticosteroids
(prednisone 1 to 2 mg/kg/day). In the presence of progressive renal failure, the patient

should be hospitalized for more aggressive therapy with IV corticosteroids with or
without other immunosuppressive agents. “Pulse” therapy with methylprednisolone (30
mg/kg, 1,500 mg maximum) may be indicated in the presence of rapidly progressive
renal disease. The combination of cyclophosphamide and rituximab, as well as the oral
agent mycophenolate mofetil, has also shown promise in the treatment of lupus