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Question for Dr. V
lupylisa44 posted:
My doctors are stumped and I could use your input. My lupus/nephritis is flaring. My serum creatine increased to 1.3, my urine protein is 2.3 g and my C3 has decreased. I have increased my cellcept to 2000mg and medrol 8mg bid.

My blood pressure is high and I seem to be allergic or sensitive to most BP meds ( Losartan, irbesaertan, lisinopril and now Tekturna) My question is: Do you know of any other meds that could lower my BP and help protect my kidneys?

With love, with patience and with faith, we'll make our way.
lupylisa44 responded:
Was just reading the information on Tekturna and in the Warnings it says " WARNINGS AND PRECAUTIONS: has been reported to cause exacerbation or activation of systemic lupus erythematosus.

Why on earth would a doctor prescribe medicine that would exacerbate lupus ,especially since my lupus was already active?
With love, with patience and with faith, we'll make our way.
R Swamy Venuturupalli, MD, FACR responded:

Dear Lupylisa,

I'm so sorry that things are not going great for you. I think you had reached out earlier with a similar question. If I remember correctly, your lupus nephritis was not responsive to cytoxan. In cases where the standard treatments are not working, we consider unapproved/ non-standard approaches.

There are numerous case reports that Rituximab might be of benefit in cases of lupus nephritis. As you may know, when Rituximab was studied in a controlled study, it failed to meet the primary end points. The trial design, where all patients were given high doses of steroids up front and the numbers of patients were not high enough to detect significant differences has been criticized extensively. This might explain why the drug did not meet the endpoints. Having said that many doctors in the lupus community, myself included, have had success in some patients with lupus using that drug. This might be an option for you to consider.

Additionally, we have been studying some medications for lupus nephritis including abatacept and we will know our preliminary data in the next month or so. A medication called epratizumab is being studied and Belimumab is also being studied in clinical trials for nephritis. Most clinical trials for nephritis require a recent renal biopsy, and I think that might be an issue for you given your past experience of bleeding after the procedure. However, depending on how bad your proteinurea is, there might be some trials that you could qualify for without a renal biopsy.

Hope that helps. Wishing you the best!
lupylisa44 replied to R Swamy Venuturupalli, MD, FACR's response:
Thank you!
With love, with patience and with faith, we'll make our way.