Nephrotic syndrome associated with focal segmental glomerulosclerosis in a patient with systemic lupus erythematosus and membranous glomerulonephritis in remission

Introduction. Systemic lupus erythematosus (SLE) is a chronic immunological disease causing a significant morbidity and mortality in younger women and involving several organs and systems, most often the kidneys, being consequently the incidence of lupus nephritis (LN) about 60%. Case report. We reported a 57 year-old patient with the diagnosed SLE in 1995. Pathohistological analysis of kidney biopsy revealed LN type V. The patient was treated with corticosteroid pulses and azathioprine during one year. A remission was achieved and maintained with prednisone, 15 mg daily. Nephrotic relapse was diagnosed in 2006 and the second kidney biopsy revealed recent kidney infarction due to extensive vasculitis. Soon, a cerebrovascul insult developed and CT-scan revealed endocranial infarctus. The patient was treated with corticosteroids and cyclophosphamide pulses (totally VI monthly pulses), and also with low-molecular heparine, anticoagulants and salicylates because of the right leg phlebothrombosis. After the pulses, the patient was adviced to take prednisone 20 mg daily and azothioprine 100 mg daily, and 6 months later mycophenolate mofetil because of persistent active serological immunological findings (ANA 1 : 320) and nephrotic syndrome. Mycophenolate mofetil was efficient in inducing and maintaining remission of nephrotic syndrome. Conclusion. The aim of LN treatment is to achieve and maintain remission, improve patients? outcome, reduce the toxicity of immunosuppressive drugs and the incidence of relapses. Mycophenolate mofetil was shown to be efficient in inducing and maintaining remission of nephrotic syndrome in the frame of LN.

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Minimal Change Disease as a Secondary and Reversible Event of a Renal Transplant Case with Systemic Lupus Erythematosus

Case Reports in Nephrology ◽

10.1155/2015/987212 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Elena Gkrouzman ◽

Kyriakos A. Kirou ◽

Surya V. Seshan ◽

James M. Chevalier

Keyword(s):

Systemic Lupus Erythematosus ◽

Nephrotic Syndrome ◽

Renal Transplant ◽

Transplant Recipient ◽

Lupus Erythematosus ◽

Minimal Change Disease ◽

Iliac Vein ◽

Minimal Change ◽

Systemic Lupus ◽

Vein Stenosis

Secondary causes of minimal change disease (MCD) account for a minority of cases compared to its primary or idiopathic form and provide ground for consideration of common mechanisms of pathogenesis. In this paper we report a case of a 27-year-old Latina woman, a renal transplant recipient with systemic lupus erythematosus (SLE), who developed nephrotic range proteinuria 6 months after transplantation. The patient had recurrent acute renal failure and multiple biopsies were consistent with MCD. However, she lacked any other features of the typical nephrotic syndrome. An angiogram revealed a right external iliac vein stenosis in the region of renal vein anastomosis, which when restored resulted in normalization of creatinine and relief from proteinuria. We report a rare case of MCD developing secondary to iliac vein stenosis in a renal transplant recipient with SLE. Additionally we suggest that, in the event of biopsy-proven MCD presenting as an atypical nephrotic syndrome, alternative or secondary, potentially reversible, causes should be considered and explored.

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Decrease in serum antiphospholipid antibody levels upon development of nephrotic syndrome in patients with systemic lupus erythematosus: Relationship to urinary loss of IgG and other factors

The American Journal of Medicine ◽

10.1016/0002-9343(92)90264-c ◽

1992 ◽

Vol 92 (4) ◽

pp. 357-362 ◽

Cited By ~ 20

Author(s):

María Esther Pérez-Vázquez ◽

Javier Cabiedes ◽

Antonio R. Cabral ◽

Donato Alarcón-Segovia

Keyword(s):

Systemic Lupus Erythematosus ◽

Nephrotic Syndrome ◽

Lupus Erythematosus ◽

Antiphospholipid Antibody ◽

Systemic Lupus ◽

Antibody Levels

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1107 INFANTILE SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) ASSOCIATED WITH CHROMOSOMAL ABNORMALITIES PRESENTING AS NEPHROTIC SYNDROME

Pediatric Research ◽

10.1203/00006450-197804001-01113 ◽

1978 ◽

Vol 12 ◽

pp. 548-548 ◽

Cited By ~ 3

Author(s):

A Ty ◽

B P Fine

Keyword(s):

Systemic Lupus Erythematosus ◽

Nephrotic Syndrome ◽

Lupus Erythematosus ◽

Chromosomal Abnormalities ◽

Systemic Lupus

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Membranous nephropathy

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.210804 ◽

2010 ◽

pp. 3985-3988

Author(s):

Dwomoa Adu

Keyword(s):

Prostate Cancer ◽

Systemic Lupus Erythematosus ◽

Nephrotic Syndrome ◽

Basement Membrane ◽

Autoimmune Diseases ◽

Outer Surface ◽

Glomerular Basement Membrane ◽

Lupus Erythematosus ◽

Membranous Nephropathy ◽

Systemic Lupus

Membranous nephropathy, which accounts for 20 to 30% of cases of the nephrotic syndrome in adults, is defined histologically by the presence of subepithelial immune deposits on the outer surface of the glomerular basement membrane. The immune mechanisms that lead to this are uncertain, and most cases are of unknown cause (idiopathic), but the condition can be associated with autoimmune diseases (systemic lupus erythematosus), malignancy (in 10% of cases, most commonly lung and prostate cancer), drugs, and infections....

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