A Case of Full-House Nephropathy with Anti-Nuclear Antibody Negative Lupus (original) (raw)

Abstract

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.

Figures (1)

[Figure 1: Renal biopsy showed increase in glomerular mesangial matrix and cellularity, capillary obliteration and thickened basement membranes A) PAS x100, B) PAS x400). There are subendothelial deposits lining along the capillary loops, C) MT x1000). Immunofluorescence microscop revealed positivity both in the mesangium and along capillary loops in a coarsely granular pattern, D) Anti IgG FITC x400). (60% dysmorphic) were observed in every area in the urine microscopy. Urine culture was sterile. 24-hour urine proteinuria was 0.8 g. Serological examinations revealed that ANA, anti- dsDNA, ANCAs, anti-RNP antibodies, anti-SSA antibody, anti- SSB antibody, anti-sm antibody ve anti-cardiolipin antibodies were negative. Hepatitis markers were negative for hepatitis B and C. Other laboratory parameters including liver-cardiac markers were all normal. Ultrasonography revealed normal kidneys. Renal biopsy was performed because of an active urinary sediment and proteinuria and was consistent with diffuse proliferative glomerulonephritis (Class-[V, GA) with activity index 9 (Figure 1A-D). In the immunofluorescence (IF) examination, immune deposits, such as IgA (+++), IgG (++), IgM (+), Clq (++) and C3 (+++), were detected in accordance with ‘full house nephropathy’. Examination of the joints revealed mild pain and swelling at the metacarpal-phalangeal joints, wrists, knees, and ankles bilaterally. The rest of the physical examination was unremarkable. There were no pathological findings on the ophthalmic examination. Laboratory analysis revealed a creatinine level of 1 mg/dL, an erythrocyte sedimentation rate of 47 mm/hr, and a C-reactive protein (CRP) level of 1.7 mg/dL. Thin coarse granular casts, 14 leukocytes and 10 erythrocytes ](https://figures.academia-assets.com/116165721/figure_001.jpg)

Figure 1: Renal biopsy showed increase in glomerular mesangial matrix and cellularity, capillary obliteration and thickened basement membranes A) PAS x100, B) PAS x400). There are subendothelial deposits lining along the capillary loops, C) MT x1000). Immunofluorescence microscop revealed positivity both in the mesangium and along capillary loops in a coarsely granular pattern, D) Anti IgG FITC x400). (60% dysmorphic) were observed in every area in the urine microscopy. Urine culture was sterile. 24-hour urine proteinuria was 0.8 g. Serological examinations revealed that ANA, anti- dsDNA, ANCAs, anti-RNP antibodies, anti-SSA antibody, anti- SSB antibody, anti-sm antibody ve anti-cardiolipin antibodies were negative. Hepatitis markers were negative for hepatitis B and C. Other laboratory parameters including liver-cardiac markers were all normal. Ultrasonography revealed normal kidneys. Renal biopsy was performed because of an active urinary sediment and proteinuria and was consistent with diffuse proliferative glomerulonephritis (Class-[V, GA) with activity index 9 (Figure 1A-D). In the immunofluorescence (IF) examination, immune deposits, such as IgA (+++), IgG (++), IgM (+), Clq (++) and C3 (+++), were detected in accordance with ‘full house nephropathy’. Examination of the joints revealed mild pain and swelling at the metacarpal-phalangeal joints, wrists, knees, and ankles bilaterally. The rest of the physical examination was unremarkable. There were no pathological findings on the ophthalmic examination. Laboratory analysis revealed a creatinine level of 1 mg/dL, an erythrocyte sedimentation rate of 47 mm/hr, and a C-reactive protein (CRP) level of 1.7 mg/dL. Thin coarse granular casts, 14 leukocytes and 10 erythrocytes

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