Systemic lupus erythematosus acute renal failure

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

The nonsalicylate NSAIDs can also affect renal function. Risk factors fc>r NSAID-induced acute renal failure include congestive heart feilure, glomerulonephritis, chronic renal insufficiency, cirrhosis, systemic lupus erythematosus, diabetes mellitus, significant atherosclerotic disease in the elderly and use of diuretics. NSAIDs can adversely affect cardiovascular homeostasis and can be a risk factor for the onset or exacerbation of heart feilure. 

Hilepo JN, Bellucci AG, Mossey RT. Acute renal failure caused by "cat s claw" herbal remedy in a patient with systemic lupus erythematosus. Nephron 1997 77 361. 

Acute renal failure was reported in a 35-year-old woman with systemic lupus erythematosus taking four capsules daily of a cat s claw product (species unspecified) for an unspecified length of time. The woman was also taking other medications including prednisone, atenolol, metolazone, furosemide, and nifedipine. Biochemical parameters for renal function were reported to return to normal after cessation of the cat s claw product (Hilepo et al. 1997). 

---