奥妥珠单抗序贯贝利尤单抗治疗以膜性肾病起病的狼疮性肾炎一例OA

This article reports a case of an elderly male patient presenting with nephrotic syndrome.Re-nal biopsy pathology indicated membranous nephropathy,with both renal tissue staining for M-type phospho-lipase A2 receptor(PLA2R)and serum anti-PLA2R antibodies being negative.Nephrotic syndrome achieved remission following treatment with prednisone combined with tacrolimus;however,the patient relapsed during tacrolimus maintenance therapy.Subsequent laboratory evaluation revealed positive anti-nuclear antibodies and anti-double-stranded DNA antibodies,accompanied by decreased complement levels.Exostosin 1 and Exostosin 2 staining performed on the initial renal biopsy specimen yielded positive results,leading to a diagnosis of lupus nephritis.Due to the patient's history of rituximab-related allergic reactions,pulmonary infection,and acute kidney injury,the subsequent treatment regimen consisted of obinutuzumab sequentially combined with beli-mumab,in addition to prednisone 10 mg/d.During the two-year follow-up period,the patient's anti-double-stranded DNA antibodies converted to negative,complement levels normalized,proteinuria achieved complete remission,and no adverse events such as severe infection occurred.This article reviews the diagnosis,treat-ment,and relevant literature for this case,aiming to provide clinical insights for the early diagnosis and selec-tion of therapeutic strategies for similar patients.