CRCM  Vol.3 No.1 , January 2014
Acute renal failure secondary to lupus nephritis confirmed by renal biopsy with an unusually normal immunological profile
ABSTRACT

The gold standard to diagnose the lupus nephritis is the renal biopsy. It provides information not only for diagnosis but also for the treatment plan and the prognosis. Laboratory studies, including the immunological profile, play an essential role in diagnosing and evaluating the lupus nephritis activity. The patient is unlikely to have the active lupus nephritis with the combination of anti-ds DNA, anti-C1q, C3 and C4 being within normal limits. In this case report, we present a patient with moderately active diffuse proliferative lupus glomerulonephritis (Class IV) confirmed by the renal biopsy, while her immunological profile is unusually normal.


Cite this paper
Liu, Z. , Ofosu, A. , Williams, R. and Grewal, N. (2014) Acute renal failure secondary to lupus nephritis confirmed by renal biopsy with an unusually normal immunological profile. Case Reports in Clinical Medicine, 3, 6-9. doi: 10.4236/crcm.2014.31002.
References
[1]   Mok, C.C. (2012) Understanding lupus nephritis: Diagnosis, management, and treatment options. International Journal of Women’s Health, 4, 213-222.

[2]   Mok, C.C. (2006) Therapeutic options for resistant lupus nephritis. Seminars in Arthritis and Rheumatism, 36, 71-81. http://dx.doi.org/10.1016/j.semarthrit.2006.04.008

[3]   Bertsias, G., Gordon, C. and Boumpas, D.T. (2008) Clinical trials in systemic lupus erythematosus (SLE): Lessons from the past as we proceed to the future—The EULAR recommendations for the management of SLE and the use of end-points in clinical trials. Lupus, 17, 437-442. http://dx.doi.org/10.1177/0961203308090031

[4]   Weening, J.J., D’Agati, V.D., Schwartz, M.M., Seshan, S.V., Alpers, C.E., Appel, G.B., Balow, J.E., Bruijn, J.A., Cook, T., Ferrario, F., Fogo, A.B., Ginzler, E.M., Hebert, L., Hill, G., Hill, P., Jennette, J.C., Kong, N.C., Lesavre, P., Lockshin, M., Looi, L.M., Makino, H., Moura, L.A. and Nagata, M. (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Journal of the American Society of Nephrology, 15, 241-250.
http://dx.doi.org/10.1097/01.ASN.0000108969.21691.5D

[5]   Mittal, B., Rennke, H. and Singh, A.K. (2005) The role of kidney biopsy in the management of lupus nephritis. Current Opinion in Nephrology and Hypertension, 14, 1-8. http://dx.doi.org/10.1097/00041552-200501000-00002

[6]   Sinico, R.A., Radice, A., Ikehata, M., Giammarresi, G., Corace, C., Arrigo, G., Bollini, B. and Li, V.M. (2005) Anti-C1q autoantibodies in lupus nephritis: Prevalence and clinical significance. Annals of the New York Academy of Sciences, 1050, 193-200.
http://dx.doi.org/10.1196/annals.1313.020

[7]   Moroni, G., Radice, A., Giammarresi, G., Quaglini, S., Gallelli, B., Leoni, A., Li Vecchi, M., Messa, P. and Sinico, R.A. (2009) Are laboratory tests useful for monitoring the activity of lupus nephritis? A 6-year prospective study in a cohort of 228 patients with lupus nephritis. Annals of the Rheumatic Diseases, 68, 234-237.
http://dx.doi.org/10.1136/ard.2008.094508

[8]   Swaak, A.J., Groenwold, J. and Bronsveld, W. (1986) Predictive value of complement profiles and anti-dsDNA in systemic lupus erythematosus. Annals of the Rheumatic Diseases, 45, 359-366.
http://dx.doi.org/10.1136/ard.45.5.359

[9]   Christopher-Stine, L., Siedner, M., Lin, J., Haas, M., Parekh, H., Petri, M. and Fine, D.M. (2007) Renal biopsy in lupus patients with low levels of proteinuria. The Journal of Rheumatology, 34, 332-335.

[10]   Cameron, J.S. (1999) Lupus nephritis. Journal of the American Society of Nephrology, 10, 413-424.

[11]   Contreras, G., Pardo, V., Cely, C., Borja, E., Hurtado, A., De La Cuesta, C., Iqbal, K., Lenz, O., Asif, A., Nahar, N., Leclerq, B., Leon, C., Schulman, I., Ramirez-Seijas, F., Paredes, A., Cepero, A., Khan, T., Pachon, F., Tozman, E., Barreto, G., Hoffman, D., Almeida Suarez, M., Busse, J.C., Esquenazi, M., Esquenazi, A., Garcia Mayol, L. and Garcia, E.H. (2005) Factors associated with poor outcomes in patients with lupus nephritis. Lupus, 14, 890-895. http://dx.doi.org/10.1191/0961203305lu2238oa

[12]   Ruiz Irastorza, G., Espinosa, G., Frutos, M.A., Jimenez Alonso, J., Praga, M., Pallares, L., Rivera, F., Robles Marhuenda, A., Segarra, A. and Quereda, C. (2012) Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and Spanish Society of Nephrology (S.E.N.). Nefrologia, 32, 1-35.

[13]   Mok, C.C. (2010) Biomarkers for lupus nephritis: A critical appraisal. Journal of Biomedicine and Biotechnology, 2010, Article ID: 638413.
http://dx.doi.org/10.1155/2010/638413

[14]   Davidson, A. and Aranow, C. (2006) Pathogenesis and treatment of systemic lupus erythematosus nephritis. Current Opinion in Rheumatology, 18, 468-475.

[15]   Houssiau, F.A., Vasconcelos, C., D’Cruz, D., Sebastiani, G.D., Garrido Ed Ede, R., Danieli, M.G., Abramovicz, D., Blockmans, D., Mathieu, A., Direskeneli, H., Galeazzi, M., Gul, A., Levy, Y., Petera, P., Popovic, R., Petrovic, R., Sinico, R.A., Cattaneo, R., Font, J., Depresseux, G., Cosyns, J.P. and Cervera, R. (2002) Immunosuppressive therapy in lupus nephritis: The Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis & Rheumatism, 46, 2121-2131. http://dx.doi.org/10.1002/art.10461

[16]   Illei, G.G., Austin, H.A., Crane, M., Collins, L., Gourley, M.F., Yarboro, C.H., Vaughan, E.M., Kuroiwa, T., Danning, C.L., Steinberg, A.D., Klippel, J.H., Balow, J.E. and Boumpas, D.T. (2001) Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Annals of Internal Medicine, 135, 248-257.
http://dx.doi.org/10.7326/0003-4819-135-4-200108210-00009

[17]   Appel, G.B., Contreras, G., Dooley, M.A., Ginzler, E.M., Isenberg, D., Jayne, D., Li, L.S., Mysler, E., SanchezGuerrero, J., Solomons, N. and Wofsy, D. (2009) Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. Journal of the American Society of Nephrology, 20, 1103-1112.
http://dx.doi.org/10.1681/ASN.2008101028

 
 
Top