POS-461 A LUPUS NEPHROLOGIST'S NIGHTMARE- MANAGEMENT OF A YOUNG PATIENT WITH SEVERE COMBINED CLASS IV AND V LUPUS NEPHRITIS,STEROID INTOLERANCE AND COMCOMITANT HEPATITIS B VIRAL LOAD

Lupus nephritis (LN) is an increasing and prevalent complication of patients with lupus disease, occurring in up to 45% this population. Significant gradual podocyte loss nephron accompanied each episode acute flare. Early diagnosis treatment initiation paramount preserving kidney function LN. In patient advanced combined class IV V lupus, management often tortuous produces a poor outcome. Patients steroid tolerance are particularly at risk limited therapy. Moreover, the presence associated viral infection such as hepatitis B, progression liver failure start immunosuppressant agents for may limit use aggressive immune suppression paper, we present 37 year old Asian-American female no significant past medical history presented clinical features nephrotic syndrome 35 lbs weight gain , body swelling uncontrolled blood pressure, 14 g/g proteinuria. She underwent renal biopsy findings pre- immunosuppression workup reveals positive B load > 25 million copies. Patient was unable tolerate greater than 20 mg /day prednisone dosage due several side effects. Treatment concurrent therapy Hepatitis well substituting Tacrolimus doses steroids addition Mycophenolate induction able clearance 30% reduction proteinuria 3 months. Discounting description providing free approach LN management, abstract unique that it revisits common treating first before commencing during interim delay could be detrimental ESRD long term.