she developed hematuria
and non-nephrotic proteinuria with a creatinine elevation
to 1.8 mg/dL, and she received pulse therapy
with methylprednisolone. High-dose prednisone
and chloroquine were maintained, and she also
received three doses of monthly pulse therapy with
cyclophosphamide. She then returned to azathioprine
treatment (2 mg/kg/day) for 3 years, with total
remission. Anti-dsDNA and antiphospholipid antibodies
(anticardiolipin and lupus anticoagulant)
were negative. Her menarche occurred at the age
of 16 (however, her two sisters experienced
menarche at the age of 12). Her hormonal levels
were normal: oestrogen 38 ng/mL (22–215 ng/mL),
progesterone 0.3 ng/mL (0.4–1.1 ng/mL), luteinizing
hormone 4.6 IU/L (2.2–6.8 IU/L) and follicle stimulating
hormone 4.3 IU/L (2.4–9.3 IU/L). She denied
any sexual activity. Currently, she is 20 years old and
is in clinical remission on chloroquine, azathioprine
(2 mg/kg/day) and prednisone (5 mg/day). Her menstrual
cycles have been regular since menarche, and
she has complete development of secondary sexual
characteristics.