Rare Case: 70 Year Old Patient with Seronegative Lupus Nephritis (original) (raw)
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Cureus
Systemic lupus erythematosus (SLE) is a systemic autoimmune condition with many clinical presentations. It is classically seen in young to middle-aged females and can present with cutaneous, renal, serosal, hematological, joint, and/or neurological manifestations at the time of diagnosis or may develop over the course of the disease. Late-onset SLE or SLE in the elderly is a subtype that differs from the classic SLE in age group, clinical presentation, involvement of organs, and severity. Here, we present the case of a geriatric Hispanic male noted to have worsening renal function. The patient was diagnosed with lupus nephritis (LN) upon obtaining serological markers and renal biopsy. LN, a renal sequela of SLE, presents with a full-house immunofluorescence pattern. LN, along with high titers of the antinuclear antibody (ANA) and/or antidouble-stranded DNA (anti-dsDNA) antibody, is an effective tool to diagnose SLE in patients without extrarenal manifestations of the disease. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid downtrend of creatinine, resulting in stabilization of renal function and deferring the need for a hemodialysis. This case highlights the topic of late-onset SLE presenting with LN in geriatric patients.
Background: Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE).The world Health Organization (WHO) and International Society of Nephrology/Renal Pathology Society (ISN/RPS 2003) can correlate the histopathology pattern with clinical renal syndrome and provide valuable information regarding diagnosis, prognosis and management guidelines. Objective: To evaluate the main clinical, laboratory and histopathological characteristics of lupus nephritis (LN), and find the clinicopathologic correlation of renal biopsy lupus classification. Patients and methods: This study comprised a total of 38 adults LN patients, 36Females (94.7%), and 2 males (5.3%) with female to male ratio (18:1), mean age of 26.7 ± 8.95ys, urban patients 24 (63.2%) and rural 14 (36.8%). All patients were subjected to complete clinical, laboratory, and native renal biopsy histopathological evaluation through one year. Biopsies were examined and categorized according to ISN/RPS 2003 classifications. Results: The most frequent presenting features of SLE were mucocutaneous found in (78.9%), serositis (47.4%) and hematological disorders (23.7%).The frequencies of LN histopathological patterns were as follow: diffuse proliferative LN (class IV) found in 21 cases (55.3%), followed by class III found in 12 patients (31.5%) then class V in 4cases (10.5%) and lastly class II found in 1case (2.6%). A significant association found between nephrotic syndrome, edema and class V LN (p = 0.016 & p=0.024) respectively, also a significant associations between nephritic syndrome, hypertension, decreased estimated GFR and microscopic hematuria and class IV LN (p =0.048, p =0.01, p = 0.04 & p=0.02) respectively. While no significance found between LN class III or IV and each of arthritis, CNS, serositis, SLE disease activity index (SLEDAI), antiphospholipid syndrome (APS) and cutaneous manifestations. Conclusion: Our study demonstrated that diffuse proliferative LN class IV was the predominant pattern followed by class III. Obvious correlation found between clinical, laboratory and renal histopathology of lupus nephritis. Renal biopsy remains the corner stone in diagnosis, management and prognosis of the disease.
Lupus nephritis in a patient without evidence of systemic lupus erythematosus
2017
According to the American College of Rheumatology and Systemic Lupus International Collaborating Clinics, the diagnosis criteria for systemic lupus erythematosus (SLE) comprise clinical (cutaneous lupus, oral or nasal ulcers, alopecia, arthritis, serositis, renal or neurologic involvement, haemolytic anaemia, leukopaenia and thrombocytopaenia) and immunological (ANA, anti-dsDNA, anti -Sm, antiphospholipid antibody, hypocomplementaemia, and positive Coombs) parameters. Four criteria are needed to make a diagnosis, with at least one of these clinical, and one immunological. Nevertheless, in some cases, diagnosis can be established with a renal biopsy showing lupus nephritis, together with ANA and anti -dsDNA.
A Case of Full-House Nephropathy with Anti-Nuclear Antibody Negative Lupus
Turkish Nephrology Dialysis Transplantation, 2014
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the development of antibodies against a variety of nuclear and cytoplasmic antigens. SLE renal involvement is referred to as 'lupus nephritis' and is generally associated with anti-nuclear antibody (ANA) positivity. ANA is negative in approximately 5% of patients diagnosed with SLE. Existence of full-house nephropathy is generally associated with lupus nephritis. Herein, we present a case of full-house nephropathy in a 48-year-old male patient with negative serology for SLE. The patient had signs of lupus such as oral aphthae, symmetrical polyarthritis, and diffuse proliferative glomerulonephritis.
Lupus Nephritis diagnosed by stand-alone renal histopathological findings in a middle-aged male
JMS SKIMS, 2020
Systemic lupus erythematosus (SLE) is a systemic autoimmune condition, characterized by the production of autoantibodies, predominantly against nuclear antigens. It primarily affects women of childbearing age. Men account for 4-22% of all cases in various series (1,2). Lupus nephritis can be diagnosed with high sensitivity and specificity based on histopathological criteria alone (3). We report lupus nephritis in a 50-year-old male diagnosed solely on renal histopathological findings.
Rheumatology International
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that may affect any organ of the body. We report here an unusual case of seronegative SLE presented as vasculitis with rash, lower gastrointestinal system bleeding and acute renal failure. The patient was a 13-year-old boy, with abdominal distention, pretibial edema, arthritis and petechia on bilateral ankles. He had deteriorated renal functions (creatinine 1.65 mg/dl), hypoalbuminemia (1.6 g/dl) and hypocomplementemia with nephrotic range proteinuria and hematuria. He developed pleural effusion and peritonitis. Serum ANA, anti dsDNA, p ANCA, c ANCA, anticardiolipin IgM and IgG titers were negative. A renal biopsy was performed which revealed diffuse proliferative glomerulonephritis with full-house staining pattern in immunofluorescent microscopic examination suggesting Class IV Lupus Nephritis. He was administered a total of six courses of monthly intravenous pulse methyl prednisolone, dipyridamole, oral cyclophosphamide followed by azothiopirine and oral prednisolone therapy. The renal functions and serum albumin levels turned normal but peritonitis persisted and disappeared after the third pulse steroid therapy. In conclusion, we presented this patient to remind the possibility of SLE in such seronegative patients with unusual findings in order to avoid the delay in the management of this disease with high mortality and morbidity if not treated. Full-house nephropathy is an important clue especially for the diagnosis of ANA negative SLE.
CASE REPORT: PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND MANIFESTATIONS OF LUPUS NEPHRITIS (Atena Editora), 2023
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology. It has a very varied clinical picture, which may involve skin, joint, vascular, renal, neurological and other systems. Renal involvement is prevalent and serious, requiring careful clinical management. Therefore, this article is a case report of a patient whose follow-up and treatment were carried out in the Nephrology department of Santa Casa de Misericórdia de Passos. Data were collected from the patient's medical records and literature. The patient's informed consent form was obtained. The evolution of a patient with SLE was described, from suspicion, diagnosis, treatment, correlating with data from the literature.
Clinical aspects and risk factors of lupus nephritis: a retrospective study of 156 adult patients
Journal of International Medical Research, 2019
Objective To analyze the clinical manifestations, laboratory indexes, disease activity, and pathological types of lupus nephritis (LN) in adult patients. Methods We retrospectively analyzed the clinical manifestations, laboratory indexes, and pathological classifications of 156 adult patients first diagnosed with LN between July 2013 and November 2017. Patients were categorized according to the following criteria: active or inactive LN, LN with or without renal damage, and mild or severe LN. Results Immunoglobulin G and A levels, 24-hour proteinuria, and anti-dsDNA, anti-Sm, and anti-ribosomal P protein antibody positivity rates were all significantly increased in patients with active LN compared with inactive LN. Anti-dsDNA antibody positivity and 24-hour proteinuria were significantly increased, whereas hemoglobin, serum albumin, and C3 and C4 levels were significantly decreased in patients with LN and renal damage compared with those without renal damage. Anti-dsDNA and anti-Sm a...