{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:52:03Z","timestamp":1790790723981,"version":"4.1.0"},"reference-count":10,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,11]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus with approximately 50% of patients having renal involvement. Patients who fail to respond to appropriate induction immunosuppression are considered to have refractory disease. Refractory LN is associated with increased risk of progression to end-stage chronic kidney disease and mortality. Despite the development of modern therapeutics, refractory LN remains challenging in clinical practice and continues to be associated with treatment failure. Complement has a well-described role in the pathogenesis of LN; however, complement inhibition is not routinely used for refractory disease. We present the case of a woman in her 30s with refractory LN who presented with atypical haemolytic uraemic syndrome, macrophage activation syndrome and low-severity COVID-19 infection. She was treated with eculizumab with rapid clinical and biochemical improvement. The patient achieved complete remission of her refractory LN after eculizumab and remains in remission 2 years post eculizumab.<\/jats:p>","DOI":"10.1136\/bcr-2025-266485","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:40:16Z","timestamp":1761907216000},"page":"e266485","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Sustained remission with eculizumab in refractory lupus nephritis with atypical haemolytic uraemic syndrome"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-7019","authenticated-orcid":false,"given":"Brady","family":"Thomson","sequence":"first","affiliation":[{"name":"Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Nicholls","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"2025103103401158000_18.10.e266485.1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018019596"},{"key":"2025103103401158000_18.10.e266485.2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.10.017"},{"key":"2025103103401158000_18.10.e266485.3","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/s12882-020-01888-5","article-title":"A systematic review of the role of eculizumab in systemic lupus erythematosus-associated thrombotic microangiopathy","volume":"21","author":"Wright","year":"2020","journal-title":"BMC Nephrol"},{"key":"2025103103401158000_18.10.e266485.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-020-00571-1"},{"key":"2025103103401158000_18.10.e266485.5","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2016.70"},{"key":"2025103103401158000_18.10.e266485.6","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1177\/09612033211033980","article-title":"Treatment outcomes in refractory lupus nephritis: Data from an observational study","volume":"30","author":"Gururani","year":"2021","journal-title":"Lupus"},{"key":"2025103103401158000_18.10.e266485.7","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-02017-5"},{"key":"2025103103401158000_18.10.e266485.8","first-page":"39","article-title":"Critical appraisal of eculizumab for atypical hemolytic uremic syndrome","volume":"7","author":"Palma","year":"2016","journal-title":"J Blood Med"},{"key":"2025103103401158000_18.10.e266485.9","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.semarthrit.2018.01.004","article-title":"Membrane attack complex (mac) deposition in lupus nephritis is associated with hypertension and poor clinical response to treatment","volume":"48","author":"Wang","year":"2018","journal-title":"Semin Arthritis Rheum"},{"key":"2025103103401158000_18.10.e266485.10","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1016\/j.clml.2017.02.017","article-title":"Diagnostic Challenges of Hemophagocytic Lymphohistiocytosis","volume":"17S","author":"Otrock","year":"2017","journal-title":"Clin Lymphoma Myeloma Leuk"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266485","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:40:17Z","timestamp":1761907217000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266485"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":10,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,31]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1136\/bcr-2025-266485"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266485","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}