Abstract Background: Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10–25% of patients progressing to end-stage renal disease (ESRD). Objective: This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. Methods: A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. Results: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). Conclusions: In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.

RESUMO Objetivo: Descrever e discutir um raro caso de tamponamento cardíaco na presença de Lúpus Eritematoso Sistêmico (LES) e infecção por Citomegalovírus (CMV) em um paciente pediátrico, as associações entre estas duas entidades, a abordagem diagnóstica e os possíveis tratamentos neste cenário. Descrição do caso: Paciente com nove anos de idade, sexo feminino, foi admitida no departamento de emergência com dispneia grave, hipofonese de bulhas, turgência jugular, instabilidade hemodinâmica e palidez intensa. Estava em acompanhamento ambulatorial prévio por quadro de dispneia leve, poliartrite, febre e manifestações cutâneas variadas há seis meses. Ecodopplercardiograma revelou efusão pericárdica. A paciente foi submetida à pericardiocentese seguida por drenagem pleuropericárdica em selo d’água, sem intercorrências. A investigação prosseguiu com o preenchimento de critérios clínico-laboratoriais para LES e a presença de antigenemia para CMV de 15/200.000 células. Foram iniciadas medicações para controle do LES e do CMV, com boa resposta clínico-laboratorial. Comentários: O LES pediátrico manifesta-se comumente de maneira mais grave, gerando alta morbimortalidade. Tamponamento cardíaco pode ser uma das primeiras manifestações do LES, que pode também ser precipitada por agentes infecciosos, como o CMV, levando à confusão diagnóstica e retardando o correto tratamento do paciente. Mudanças na terapêutica apropriada também devem ser consideradas na presença de ambas as condições. Com base nisso, apresentamos um caso de LES juvenil agravado por infecção por CMV e a manifestação pouco usual de tamponamento cardíaco.%

ABSTRACT Objective: To describe a rare case of cardiac tamponade in a pediatric patient with systemic lupus erythematosus (SLE) and cytomegalovirus (CMV) infection, and to discuss the relationship between these morbidities, the diagnostic approach, and the possible treatments. Case description: A 9-year-old girl presented to the emergency department with severe dyspnea, muffled heart sounds, jugular vein distention, hemodynamic instability, and intense pallor. She had previously been followed up at the outpatient clinic for a six-month history of mild respiratory distress, polyarthritis, fever, and various cutaneous manifestations. Doppler echocardiogram revealed pericardial effusion. The patient was submitted to pericardiocentesis followed by water seal pleuropericardial drainage, with no complications. The investigation continued, with fulfillment of clinical and laboratory SLE criteria plus CMV antigenemia of 15/200,000 cells. Medications to control CMV infection and SLE were then initiated, with good clinical and laboratory response. Comments: Pediatric SLE commonly manifests in a more severe form, accounting for high morbimortality. Cardiac tamponade could be one of the first manifestations of SLE, which can also be precipitated by infectious agents, such as CMV, leading to diagnostic confusion and misleading the treatment. Changes in therapeutics must also be considered in the presence of both conditions. This study presents a juvenile SLE case aggravated by a CMV infection with the unusual manifestation of cardiac tamponade.%