Q: I am 28 yrs of age and was diagnosed with SLE 1.5 yrs back. For a year SLE was managed with simple prednisone 10mg, chloroquine and nimesulide (SOS). Since 1.5 yrs, SLE manifestation in the kidneys is being observed. It started with 1+ protein in routine urine test for some months with the 24 hr urine protein test showing only a marginally high protein content. But now a year later, I have oedema on face and legs; 24 hr urine protein has reached a value of 5gm of protein/24 hrs and ESR is 100mm with other parameters normal. My medications for the past one year have been: - Prednisone 30mg on alt days (still continuing) - Endoxan 500-700mg every month (6 cycles) completed 2 months back with absolutely no reduction in protein output or ESR, instead has caused me other problems - Lasix 40mg 1 daily (oedema) since 1 month (still continuing) - Envas 5mg twice a day - Atenolol 50mg twice a day - Ditide once a day - Cell Cept (Mycophenolate mofetil) 500mg thrice a day since 1.5 months Currently my BP is 180/120mm Hg. I personally feel that my kidneys have started to fail though the serum creatinine levels are normal. Please tell me if there is some hope for me! I am not depressed but am angry and frustrated with all this. I have complete faith in my clinical immunologist.

A:It would seem that you are in good hands as far as treatment of your SLE is concerned, judging from the treatment you have received from time to time and it is also good that you have faith in your treating Rheumatologist. It would seem that you do have some involvement of the kidneys as judged by the increased protein content in the urine, but the renal function as judged by creatinine levels seems to be normal. Treatment for SLE depends upon the clinical features at a given point in time and the best judge of this is the treating rheumatologist, who has been managing the problem over a period of time. You seem to be on a good combination of immuno-suppressant medication at present with Endoxan and Mycophenolate. If it seemed that this combination was not completely controlling disease activity, one could also consider Methotrexate and/or Azathiaprine. I do not think that you should get despondent or allow yourself to be frustrated but should continue follow up with your treating Rheumatologist.