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Kidney Week

Abstract: PO0181

Renal Limited Lupus-Like Nephritis in an Elderly Male

Session Information

  • AKI Mechanisms - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 103 AKI: Mechanisms

Authors

  • Gelaidan, Abdulhadi Talal, Emory University School of Medicine, Atlanta, Georgia, United States
  • Abaalkhail, Saud O., Saint Vincent Hospital, Worcester, Massachusetts, United States
  • Caberto, Sheryl C., Emory University School of Medicine, Atlanta, Georgia, United States
Introduction

Lupus nephritis is a major cause of morbidity in Systemic Lupus Erythematosus (SLE). 60% of SLE patients develop renal impairment, which is more common in age < 55 years old. SLE has a female predominance with a female-to-male ratio of 8:1. We report a case of an elderly male, who has negative serology and absence of extra-renal manifestations of SLE, diagnosed with renal limited lupus-like nephritis (RLLLN).

Case Description

A 76-year-old Caucasian male with no previous history of renal or autoimmune diseases was admitted because of acute kidney injury (AKI). Patient had no history of joint pain and swelling, rash, or oral ulcers. He was not taking NSAID or Hydralazine. Laboratory test showed creatinine 2.7 mg/dL, serum albumin 2.1 g/dL, urine protein creatinine ratio 725mg/g, and urinalysis with dysmorphic RBC of >5 RBC/HPF. Serology showed negative anti-dsDNA, ANA titer <1:40 and undetectable complements C3 and C4. Hepatitis B and C, Human immunodeficiency virus, and rapid plasma reagin were also negative. Patient's renal function continued to worsen that he eventually required hemodialysis. A renal biopsy was performed. Light microscopy revealed diffuse endocapillary hypercellularity and no crescent lesion. There was a full house with global granular mesangial and basement membrane staining for IgG, IgA, IgM, C1q, C3, free kappa and lambda light chains under immunofluorescence microscopy. Electron microscopy revealed mesangial and subendothelial dense deposit and segmental duplication. All these findings are consistent with RLLLN.

Discussion

This is a case of an elderly male patient who developed AKI with kidney biopsy that showed lupus nephritis; however, ANA and anti-dsDNA antibody were negative and there were no clinical manifestations of SLE. The patient was treated with Methylprednisolone, which was followed by Prednisone and Mycophenolate Mofetil (MMF). On 1-month follow-up, there was improvement in C3 and C4, and 24-hour CrCl estimated the GFR of 35 ml/min; hence, hemodialysis was discontinued. On 6-month follow-up, serum creatinine 1 mg/dL, BUN 14 mg/dL, and GFR >60 ml/min. Our patient’s kidney function recovered; however, there is no definite prediction of RLLLN prognosis due to limited data. 47% had a poor outcome with a permanent decrease of renal function and 62 % of patients with poor outcome had glomerular crescents involving 43–75% of the glomeruli.