ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO1793

Is It Systemic Lupus Erythematosus Nephritis or Not?

Session Information

Category: Trainee Case Report

  • 1202 Glomerular Diseases: Immunology and Inflammation


  • Pennekamp, Alexander, The Christ Hospital, Cincinnati, Ohio, United States
  • Pembaur, Karl Berthold, The Kidney and Hypertension Center, Cincinnati, Ohio, United States

IC-MPGN (immune complex-mediated glomerulonephritis) is a histopathological finding that is associated with infection, immune-complex deposition, monoclonal gammopathies as well as autoimmune disorders such as lupus, Sjögren's, and rheumatoid arthritis. MPGN traditionally has been classified as I-III depending on the pathology findings. More recently, an alternative classification system based on the pathological process has been developed (immune complex-mediated vs complement-mediated). In cases of IF showing IgG +/- C3, a tentative diagnosis of immune-complex mediated MPGN can be made. MPGN treatment is aimed first at treating the underlying cause. In the case where a cause cannot be found, as in our case of biopsy-proven IC-MPGN with negative serologies, the underlying mechanism is not clear.

Case Description

71-year-old female with PMHx aortic valve replacement, HTN, CKD-I presented with constitutional symptoms, and AKI on CKD with proteinuria. She was found to have biopsy-proven immune complex mediated MPGN, but the etiology was unclear due to negative: ANA, anti-Smith, anti-Ro/SS, anti-La/SSB, Hep B/C, cryoglobulins, CCP, CRP, ESR, K/L. The biopsy pattern was consistent with Lupus Type IV/V, with EM findings showing scattered sub endothelial dense deposits and full house IF staining pattern. CT abdomen/pelvis was negative. Further testing and workup for malignancy were negative. She was started on high-dose steroids for initial treatment of presumptive seronegative lupus nephritis. Serologies were repeated and all were negative. Patient showed improvement with initiation of mycophenolate + steroids; proteinuria and creatinine improved on follow-up.


The optimal initial treatment of idiopathic/seronegative immune complex-mediated MPGN has not been established. In this case, the patient improved with aggressive steroid treatment with a tapering dose after starting mycophenolate. Proteinuria which was initially nephrotic at 14 g/g is now near 0.2 g/g.