Efficacy and safety of bortezomib in refractory lupus nephritis: a single-center experience

Background and Objectives Resistant lupus nephritis (LN) has been associated with the persistence of long-lived plasma cells. Preliminary studies identified bortezomib as a potential treatment option for patients with refractory LN. The aim of this study was to analyze the efficacy and safety of bortezomib in the treatment of severe refractory LN. Methods This retrospective study included 12 female patients diagnosed for the first time with class IV or IV/V LN with acute or rapidly progressive kidney injury ( n = 11) and/or severe nephrotic syndrome ( n = 1) who showed resistance to induction therapy with cyclophosphamide, steroids, mycophenolate, and rituximab, and were treated with either intravenous or subcutaneous bortezomib plus intravenous dexamethasone. Results All patients with acute or rapidly progressive kidney injury showed a significant reduction in both biochemical and immunological activity after a mean of 6 (minimum 5, maximum 7) weekly cycles of bortezomib regimen, with a significant increase in C3 levels and a significant decrease of anti-ds DNA antibody titers, Systemic Lupus Erythematosus Disease Activity Index score, serum creatinine, and proteinuria. One patient (8.3%) achieved a complete response, and 10 patients (83.4%) achieved a partial response. During follow-up, all these patients maintained partial responses under treatment with mycophenolate and low-dose glucocorticoids. The patient with refractory nephrotic syndrome showed a partial response but relapsed 11 months after the end of bortezomib treatment and was resistant to treatment. A significant decrease in serum IgG levels after initiation of bortezomib treatment was observed in all patients, five of them (41.6%) showed hypogammaglobulinemia (<500 mg/dl), but no patient suffered from opportunistic infections; in only two patients (16.6%) hypogammaglobulinemia persisted at the end of follow-up. Two patients (16.6%) suffered from sensory neuropathy, which led to bortezomib treatment discontinuation. Conclusions Bortezomib may be an effective option for refractory LN, but close monitoring must be performed for possible adverse events such as peripheral neuropathy and hypogammaglobulinemia.

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Baseline HDAC6 and TFF3 proteins overexpression as prognostic markers of lupus nephritis relapse

Journal of Nephropathology ◽

10.34172/jnp.2020.e14 ◽

2020 ◽

Vol 9 (2) ◽

pp. e14-e14

Author(s):

Eman Hassan Abdelbary ◽

Noha Farouk Ahmed ◽

Adel Abdelmohsen Ghorab

Keyword(s):

Lupus Nephritis ◽

Serum Creatinine ◽

Lupus Erythematosus ◽

Kidney Diseases ◽

Activity Index ◽

Kidney Injury ◽

Class Iii ◽

Clinicopathologic Characteristics ◽

Chronicity Index

Introduction: Lupus nephritis (LN) is a substantial manifestation of systemic lupus erythematosus (SLE). HDAC6 is overexpressed in various kidney diseases, and its inhibition slows kidney injury progression. Urinary TFF3 increases in chronic kidney diseases (CKDs) and may be associated with patient’s outcome. Objectives: This study aimed to examine the relationship between renal HDAC6 and TFF3 proteins expression and with clinicopathologic characteristics and outcome of LN. Patients and Methods: HDAC6 and TFF3 proteins’ expression was immunohistochemically detected in 56 cases of LN. They were correlated to patients’ age, gender, urinary 24 hours protein and serum creatinine levels at baseline and during follow up. Additionally, they were correlated to LN classes, activity index (AI) and chronicity index (CI) and relapse free survival (RFS). Results: HDAC6 overexpression was significantly associated with serum creatinine and 24 hours proteinuria levels at baseline (P = 0.041 and P =0.026 respectively) and during follow up (P < 0.001). It was associated with AI and CI of class III and IV LN (P = 0.047 and 0.003 respectively). TFF3 overexpression was associated with higher serum creatinine and more proteinuria at baseline (P = 0.015 and 0.001 respectively) and during follow up (P < 0.001). It was significantly associated with higher CI (P = 0.001). Both markers were associated with shorter RFS (P < 0.001). Conclusion: HDAC6 and TFF3 proteins are associated with clinicopathologic features of renal damage in LN. They are reliable predictors of patients’ RFS, which makes them good candidates for risk stratification of patients and targeted therapy.

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Antinuclear Antibody-Negative Lupus Nephritis with Full House Nephropathy: A Case Report and Review of the Literature

American Journal of Nephrology ◽

10.1159/000443747 ◽

2015 ◽

Vol 42 (6) ◽

pp. 451-459 ◽

Cited By ~ 22

Author(s):

Sierra C. Simmons ◽

Maxwell L. Smith ◽

April Chang-Miller ◽

Mira T. Keddis

Keyword(s):

Lupus Nephritis ◽

Renal Biopsy ◽

Lupus Erythematosus ◽

Antinuclear Antibody ◽

Leukocytoclastic Vasculitis ◽

Kidney Injury ◽

Mixed Cryoglobulinemia ◽

Close Monitoring ◽

Glomerular Diseases

Lupus nephritis (LN) is a serious and common complication of systemic lupus erythematosus (SLE) that predisposes to significant morbidity and mortality. Studies show that prompt diagnosis and treatment improves patient survival. We present a case of a 49-year-old female with an atypical presentation of LN who initially presented with new-onset hypertension, edema, arthritis, serositis and recently diagnosed leukocytoclastic vasculitis who later developed acute kidney injury, hematuria and nephrotic syndrome. Laboratory testing showed mixed cryoglobulinemia and elevated perinuclear anti-neutrophil cytoplasmic (p-ANCA) and myeloperoxidase (MPO) antibodies. SLE-related serologies were negative. Kidney biopsy showed diffuse proliferative global glomerulonephritis with a full-house nephropathy pattern on immunofluorescence suggestive of LN. Due to high clinical suspicion and renal biopsy findings, she was treated for LN with prompt renal response to immunosuppression. Cryoglobulins, p-ANCA and MPO titers normalized and the negative SLE serologies remained negative. Literature review on antinuclear antibody (ANA)-negative and seronegative LN revealed the following patient presentations: (1) renal-limited or renal and extra-renal manifestations of SLE with negative serologies and (2) renal and extra-renal manifestations of SLE with negative serologies at presentation who develop positive serologies later in follow-up. Both groups represent a unique and challenging cohort of patients who may require longer follow-up and further testing to rule out other glomerular diseases that may mimic LN on renal biopsy. The absence of SLE-related serologies should be weighed against a high pre-test probability of ANA-negative or seronegative LN. If highly suspected, the patient should be treated promptly with close monitoring.

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OP270 Why The Haute Autorité de Santé Rejects the Widespread Use Of “Mini-Bypass”/One Anastomosis Gastric Bypass For Obesity In France

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000975 ◽

2020 ◽

Vol 36 (S1) ◽

pp. 4-4

Author(s):

Jean-Charles Lafarge ◽

Denis-Jean David ◽

Cédric Carbonneil

Keyword(s):

Esophageal Cancer ◽

Gastric Bypass ◽

Adverse Events ◽

Severe Obesity ◽

One Anastomosis Gastric Bypass ◽

Close Monitoring ◽

Efficacy And Safety ◽

Multicenter Rct ◽

Nutritional Complications

IntroductionOne anastomosis gastric bypass (OAGB) has become a widespread technique over the last few years in France, without any prior assessment and despite existing controversies among bariatric surgeons. An older bypass technique for treating obesity, the Roux-en-Y gastric bypass (RYGB), is available and reimbursed, having been assessed and approved for use in 2005. In 2019, the French Haute Autorité de Santé (HAS) assessed OAGB for the treatment of severe and massive obesity. This assessment, the first in the world, was undertaken for OAGBs carried out with a 200- or 150-centimeter biliopancreatic-limb (BP-limb) length.MethodsA systematic review (SR) of the literature and consultation of a working group consisting of both healthcare professionals (clinician and surgeons) and patients were carried out. The primary aim of our assessment was to determine whether the OAGB technique can replace RYGB. The efficacy and safety profile of OAGB was compared with RYGB in adult patients with massive, severe obesity. Complications and postoperative follow up specific to OAGB were identified.ResultsThe three selected randomized controlled trials (RCTs) could not confirm the superiority or the non-inferiority of OAGB, compared with RYGB, on the selected efficacy endpoints of weight loss, resolution of comorbidities, and quality of life. Adverse events reported for OAGB included severe nutritional complications and bile reflux that could potentially lead to lower esophageal cancer. In one RCT, the frequency of serious adverse events in the OAGB group was almost two times higher than in the RYGB group.ConclusionsHAS considered that OAGB carried out with a longer (200 centimeter) BP-limb is not a validated technique for the surgical treatment of massive, severe obesity. Thus, it cannot be considered an alternative to RYGB. There were insufficient data available on OAGB performed with a 150-centimeter BP-limb. Thus, HAS recommended undertaking a multicenter RCT to assess the efficacy and safety of OAGB. Patients who have already undergone OAGB should receive the same follow up as patients who have received RYGB, including close monitoring for nutritional complications and lower esophageal cancer and an endoscopic examination five years after surgery.

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Therapeutic potential of allogeneic mesenchymal stromal cells transplantation for lupus nephritis

Lupus ◽

10.1177/0961203318804922 ◽

2018 ◽

Vol 27 (13) ◽

pp. 2161-2165 ◽

Cited By ~ 13

Author(s):

J Barbado ◽

S Tabera ◽

A Sánchez ◽

J García-Sancho

Keyword(s):

Lupus Nephritis ◽

Mesenchymal Stromal Cells ◽

Lupus Erythematosus ◽

Stromal Cells ◽

Therapeutic Potential ◽

Activity Index ◽

Disease Activity Index ◽

Controlled Clinical Trial ◽

Allogeneic Mscs

Animal and human studies have suggested the potential of mesenchymal stromal cells (MSCs) to treat systemic lupus erythematosus (SLE). Here, we present the results of compassionate MSC treatments for three SLE patients to provide the proof of concept for a randomized and controlled clinical trial. Three patients of different ethnicities who suffer from chronic SLE, and who presented with class IV active proliferative nephritis confirmed by biopsy, were treated with allogeneic MSCs from healthy donors. Ninety million cells were infused intravenously into each patient during high and very high activity disease flare-ups and follow-up was continued for 9 months. Multi-organic affectation was quantified by the SLE disease activity index (SLEDAI), and indicators of lupus nephritis activity, such as proteinuria, as well as lymphocyte and monocyte antigens and anti-HLA antibodies were measured at 1, 3, 6, and 9 months after treatment. Proteinuria levels improved dramatically during the 1st month after treatment and the ameliorations were sustained throughout the follow-up period. SLEDAI scores revealed early, durable, and substantial remissions that were complete for two patients and partial for the third patient and that permitted medication doses to be reduced 50–90%. These favourable outcomes support completion of the randomized and controlled MSC trial for SLE.

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The short-term efficacy of bortezomib combined with glucocorticoids for the treatment of refractory lupus nephritis

Lupus ◽

10.1177/0961203316686703 ◽

2017 ◽

Vol 26 (9) ◽

pp. 952-958 ◽

Cited By ~ 13

Author(s):

H Zhang ◽

Z Liu ◽

L Huang ◽

J Hou ◽

M Zhou ◽

...

Keyword(s):

Lupus Nephritis ◽

Adverse Events ◽

Partial Remission ◽

Activity Index ◽

Alternative Therapy ◽

Gastrointestinal Symptoms ◽

Disease Activity Index ◽

Albumin Level ◽

Immunological Parameters ◽

Bortezomib Treatment

Objective The treatment of refractory lupus nephritis (LN) remains challenging for clinicians because these patients either do not respond to conventional therapy or relapse during the maintenance treatment period. The aim of this study was to investigate the efficacy and safety of bortezomib combined with glucocorticoids in refractory lupus patients. Methodology Five refractory LN patients aged 21 to 43 years (four females and one male) with biopsy-proven diagnosis (four with type IV and one with type V+IV) were recruited. These patients received bortezomib therapy for four cycles (1.3 mg per square meter of body surface area as an intravenous bolus on days 1, 4, 8, and 11 of 21-day cycles) and glucocorticoids (methylprednisolone 0.5 g/d intravenously for three days, followed by prednisone 0.6 mg/kg/d orally for four weeks, with gradual tapering to 10 mg/d). Proteinuria, serum albumin and creatinine, and immunological parameters were assessed, and adverse effects were also evaluated. Results After two to four bortezomib treatment cycles, four patients achieved partial remission with decreases in SLE disease activity index scores from the range of 12–16 to that of 4–8. The patients also exhibited a decline in proteinuria and an elevation of albumin level after treatment. SCr level was decreased in three of five patients with elevated SCr at baseline. The anti-autoantibodies and complements were also improved. Adverse events were of grades 1–2 and included transient thrombocytopenia, gastrointestinal symptoms and acroesthesia. During a 6- to 24-month follow-up period, three patients achieved complete remission, and one had partial remission. However, one patient received renal replacement therapy. Conclusion Bortezomib combined with glucocorticoids reduces proteinuria, improves renal function and decreases anti-autoantibodies, with good tolerance and mild adverse events, thus representing an alternative therapy for refractory LN and warranting further study.

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A Validation of the 2018 Revision of International Society of Nephrology/Renal Pathology Society Classification for Lupus Nephritis: A Cohort Study from China

American Journal of Nephrology ◽

10.1159/000507213 ◽

2020 ◽

Vol 51 (6) ◽

pp. 483-492 ◽

Cited By ~ 2

Author(s):

Juan Tao ◽

Hui Wang ◽

Xiao-Juan Yu ◽

Ying Tan ◽

Feng Yu ◽

...

Keyword(s):

Lupus Nephritis ◽

Renal Biopsy ◽

International Society ◽

Interstitial Fibrosis ◽

Activity Index ◽

Renal Pathology ◽

Tubular Atrophy ◽

Female Ratio ◽

Renal Outcomes

Background: A revision of the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification for lupus nephritis has been published in 2018. The current study aimed to verify the utility of this system. Materials and Methods: A total of 101 lupus nephritis patients from a large Chinese cohort who underwent renal biopsy in Peking University First Hospital were reevaluated by 2 renal pathologists, who had no knowledge of the clinical findings. The association between clinical data at the time of initial renal biopsy and follow-up and pathological features were further analyzed on all patients selected. Results: The mean age of the cohort was 33 years with a male/female ratio of 1:9, and a median follow-up period of 128 months. The presence and extent of mesangial hypercellularity, endocapillary hypercellularity, global and segmental glomerulosclerosis, neutrophil exudation/karyorrhexis, glomerular hyaline deposits, extracapillary proliferation (crescents), tubular atrophy/interstitial fibrosis, and interstitial inflammation were significantly correlated with several clinical renal injury indices (systemic lupus erythematosus disease activity index, serum creatinine value, proteinuria, and C3 level) at the time of biopsy. By multivariable Cox hazard analysis, fibrous crescents, tubular atrophy/interstitial fibrosis, and the modified National Institutes of Health chronicity index were independent risk factors for patients’ composite renal outcomes (hazard ratio [HR] 4.100 [95% CI 1.544–10.890], p = 0.005; HR 8.584 [95% CI 2.509–29.367], p = 0.001; and HR 3.218 [95% CI 1.138–9.099], p = 0.028; respectively). Conclusions: The 2018 revision of the ISN/RPS classification for lupus nephritis has utility for prediction of clinical renal outcomes.

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The incidence of treatment related acute kidney injury in cancer patients: A retrospective analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14150 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14150-e14150

Author(s):

Bohdan Baralo ◽

Samia Hossain ◽

Muhammad Hanif ◽

Suhail Khokhar ◽

Sana Mulla ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Kidney Injury ◽

Close Monitoring ◽

Repeat Test ◽

Significant Incidence ◽

Improved Outcomes ◽

Platinum Based Chemotherapy ◽

Before And After

e14150 Background: Development of the Acute kidney injury (AKI) in the patients receiving chemotherapy and immunotherapy is a factor associated with higher admission to the hospital, prolonged hospitalization, increased morbidity and mortality, dose reduction, moving to less effective regimens, inability to enroll in clinical trials. Methods: A retrospective cohort of the 95 patients, who received chemo immunotherapy in the infusion center of Mercy Fitzgerald Hospital in 2018-2020 were analysed. The pool of the patients had multiple oncological pathologies and were on different chemo immunotherapeutic regimens. All creatinine levels before starting chemotherapy, before and after each cycle were assessed. We used a Kidney Disease: Improving Global Outcomes criteria to define AKI (at least 1.5 increase in creatinine within 7 days of cycle or 0.3 creatinine increase in 48 hours) and grades of AKI. We considered AKI related to chemotherapy, if it developed in specified timeframe after chemotherapy defined above. The cases when patient did not meet criteria for AKI, but had a patterns suggestive of it (no repeat test within 7 days, but repeat test within 3 weeks, with increase in creatinine > 37.5%) were defined as potentially missed AKI. Results: 12 patients developed chemoimmunotherapy related AKI (12.63%). 1 patient had 3 episodes of the AKI related to chemotherapy. 4 patients received platinum-based chemotherapy. On average every patient received 12cycles of chemotherapy. After the first two cycles of chemotherapy AKI developed in 7 Patients (58.33%). 10patients had AKI after 7 cycles (83.33%). It worth mentioning that only 42% of the chemotherapeutic cycles had follow-up creatinine within 7 days. 7 patients (7.37%) had fallen under a potentially missed AKI criteria. 2 more patients were diagnosed with AKI that was not related to the chemotherapy. Conclusions: In our study there was a significant incidence of AKI in the patients receiving chemoimmunotherapy. Current guidelines do not advocate close monitoring(weekly) of renal function in patients receiving chemoimmunotherapy unless the patient receives an chemotherapeutic agent known to cause nephrotoxicity. Repeat creatinine within 7 days after chemotherapy may be necessary to allow early detection of AKI, that can potentially to improved outcomes. Large prospective studies may be necessary to confirm our findings that very close monitoring of renal function can improve detection of the AKI and outcomes due to possibility of early intervention.

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Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study

Acta Médica Portuguesa ◽

10.20344/amp.11598 ◽

2019 ◽

Vol 32 (10) ◽

pp. 635 ◽

Cited By ~ 2

Author(s):

David Navarro ◽

Ana Carina Ferreira ◽

Helena Viana ◽

Fernanda Carvalho ◽

Fernando Nolasco

Keyword(s):

Renal Function ◽

Lupus Nephritis ◽

Renal Biopsy ◽

International Society ◽

Activity Index ◽

Renal Pathology ◽

Response To Treatment ◽

Clinical Activity ◽

Renal Outcomes

Introduction: Lupus nephritis is a serious complication of systemic lupus erythematosus. Currently, therapy is guided by findings in the renal biopsy, following the International Society of Nephrology / Renal Pathology Society classification. Austin and Hill’s histomorphological indexes are not routinely obtained. In this retrospective single-centre study, we aimed to analyze the importance and applicability of the different morphological indexes in predicting response to treatment and prognosis.Material and Methods: Patients with kidney biopsy demonstrating lupus nephritis from the 2010 – 2016 period were included. We analyzed their demographic data, comorbidities, clinical presentation and laboratorial evaluation at the time of renal biopsy. We evaluated the following outcomes: clinical remission, renal function and proteinuria at end of follow-up. Histologic analysis was performed using the International Society of Nephrology / Renal Pathology Society classification and the morphological indexes described by Austin (Activity and Chronicity) and Hill. Univariate and multivariate statistical analysis was performed using STATA software.Results: We analyzed 46 biopsy-proven lupus nephritis cases, with a median follow-up of 31.9 (13.2 – 45.6) months. Based on biopsy findings, 35 patients were started on immunosuppressive therapy. We observed that Class IV patients had, at presentation, lower estimated glomerular filtration rate (67.3 vs 94.6 mL/min; p = 0.02), higher proteinuria (4.26 vs 2.37 g/24 hours; p = 0.02) and a non-significantly higher C3 consumption (58.9 vs 77.4 mg/dL; p = 0.06). We did not observe correlations between International Society of Nephrology / Renal Pathology Society classification and the outcomes at the end of follow-up. In contrast, both the Hill biopsy index and Austin’s Chronicity index were correlated with renal function and proteinuria at the end of follow-up. Austin’s Activity index correlated with the immunological findings (C3, C4 and anti-dsDNA) at presentation.Discussion: Because clinical activity poorly correlates with histologic activity, histological findings are fundamental when assessing patients with suspected lupus nephritis. The most recent International Society of Nephrology / Renal Pathology Society report supports the European League Against Rheumatism guidelines, encouraging the adoption of histomorphological indexes when evaluating lupus nephritis. Our data, showing a correlation between the renal outcomes and the indexes described by Austin and Hill, supports this view.Conclusion: The histomorphological indexes in lupus nephritis are easily obtainable, can predict renal outcomes and may help in the management of such patients.

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Prospective validation of a novel renal activity index of lupus nephritis

Lupus ◽

10.1177/0961203316684212 ◽

2016 ◽

Vol 26 (9) ◽

pp. 927-936 ◽

Cited By ~ 9

Author(s):

G Gulati ◽

M R Bennett ◽

K Abulaban ◽

H Song ◽

X Zhang ◽

...

Keyword(s):

Lupus Nephritis ◽

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Activity Index ◽

Characteristic Curve ◽

Kidney Injury ◽

Operating Characteristic Curve ◽

Kidney Injury Molecule 1 ◽

Receiver Operating

Objectives The renal activity index for lupus (RAIL) score was developed in children with lupus nephritis as a weighted sum of six urine biomarkers (UBMs) (neutrophil gelatinase-associated lipocalin, monocyte chemotactic protein 1, ceruloplasmin, adiponectin, hemopexin and kidney injury molecule 1) measured in a random urine sample. We aimed at prospectively validating the RAIL in adults with lupus nephritis. Methods Urine from 79 adults was collected at the time of kidney biopsy to assay the RAIL UBMs. Using receiver operating characteristic curve analysis, we evaluated the accuracy of the RAIL to discriminate high lupus nephritis activity status (National Institutes of Health activity index (NIH-AI) score >10), from low/moderate lupus nephritis activity status (NIH-AI score ≤10). Results In this mixed racial cohort, high lupus nephritis activity was present in 15 patients (19%), and 71% had proliferative lupus nephritis. Use of the identical RAIL algorithm developed in children resulted in only fair prediction of lupus nephritis activity status of adults (area under the receiver operating characteristic curve (AUC) 0.62). Alternative weightings of the six RAIL UBMs as suggested by logistic regression yielded excellent accuracy to predict lupus nephritis activity status (AUC 0.88). Accuracy of the model did not improve with adjustment of the UBMs for urine creatinine or albumin, and was little influenced by concurrent kidney damage. Conclusions The RAIL UBMs provide excellent prediction of lupus nephritis activity in adults. Age adaption of the RAIL is warranted to optimize its discriminative validity to predict high lupus nephritis activity status non-invasively.

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Lupus-like membranous nephropathy. Is it lupus? Report of 5 cases in a reference hospital in Mexico

Lupus ◽

10.1177/09612033211013584 ◽

2021 ◽

pp. 096120332110135

Author(s):

Luis Manuel Ramírez-Gómez ◽

Ivette Ruiz-Leija ◽

David Martínez-Galla ◽

Jaime Antonio Borjas-García ◽

Carlos Abud-Mendoza ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Lupus Nephritis ◽

Renal Biopsy ◽

Mycophenolic Acid ◽

Lupus Erythematosus ◽

Antinuclear Antibodies ◽

Classification Criteria ◽

Normal Limits ◽

Extrarenal Manifestations

Introduction: Lupus nephritis requires antinuclear antibodies as classification criteria. There is a group of patients with nephrotic syndrome and conclusive histopathological findings for lupus nephritis, without classification criteria for systemic lupus erythematosus (SLE) or extrarenal manifestations. These groups of patients have been described as “lupus-like” nephritis or “renal-limited lupus nephritis”. Methods: Renal biopsy with histopathological evaluation with “full-house” immune-reactants in patients with negative antinuclear antibodies. Results: We report four cases with nephrotic syndrome and one with hematuria-proteinuria syndrome: two with impaired glomerular filtration rate and three with preserved renal function; urinary sediment with hematuria without dysmorphia and without extrarenal manifestations for autoimmune disease, negative antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA); normal C3 and C4 complement levels. Renal biopsy in all cases was consistent for lupus nephritis class V. All patients received treatment as lupus nephritis protocol; only one case received induction with cyclophosphamide and methylprednisolone boluses, the rest received mycophenolic acid and prednisone as induction and maintenance. Two of the cases induced with mycophenolic acid relapsed, requiring cyclophosphamide for 6 months, achieving complete remission. All patients received renin-angiotensin-aldosterone system blockade and hydroxychloroquine. At follow-up, 4 cases still have negative antibodies and are without extrarenal manifestations for SLE classification criteria. The other case, during pregnancy several years after initial diagnosis, had preeclampsia with nephrotic proteinuria and a new determination of positive ANA and anti-dsDNA antibodies, complement levels below normal limits. Conclusion: The follow-up of patients with membranous glomerulopathy must be close; lupus like nephritis may be the first manifestation of the disease.

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