Anesthetic Considerations in ESRD Secondary to Lupus Nephritis

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems, and kidney involvement in the form of lupus nephritis is common. In some patients, lupus nephritis can progress to end-stage renal disease (ESRD), requiring renal replacement therapy. Patients with ESRD secondary to lupus nephritis present unique challenges for anesthetic management due to impaired renal drug clearance, electrolyte disturbances, cardiovascular comorbidities, hematologic abnormalities, and the multisystem manifestations of SLE. We present the case of a 23-year-old woman with biopsy-proven lupus nephritis and ESRD on hemodialysis who underwent fitting and adjustment of a peritoneal dialysis catheter while awaiting kidney transplantation. Anesthetic management focused on maintaining hemodynamic stability while avoiding medications that may accumulate in the setting of renal failure. Induction of anesthesia was performed with propofol, fentanyl, and rocuronium, and anesthesia was maintained with sevoflurane. Neuromuscular blockade was reversed with sugammadex at the conclusion of the procedure. This case highlights the importance of careful medication selection and perioperative planning when providing anesthesia for patients with ESRD secondary to lupus nephritis.