ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

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

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1605

Lupus Nephritis in a Patient with Autoimmune Hepatitis: A Case Report

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kae, Soo Hyun, UConn Health, Farmington, Connecticut, United States
  • Lawlor, Erin, UConn Health, Farmington, Connecticut, United States
  • Niranjan, Sankar Narayan, Greater Hartford Nephrology, Bloomfield, Connecticut, United States
Introduction

Overlapping of autoimmune hepatitis (AIH) and lupus nephritis (LN) is a rare entity, only occurring in 1-2.6% of AIH cases, and is difficult to diagnose due to the overlap of autoimmune features. Only a few case reports have been reported in the literature.

Case Description

61-year-old male with established remote diagnosis of AIH well controlled on azathioprine on routine urinalysis had new-onset proteinuria (5 g/day) and hematuria. Renal biopsy showed membranoproliferative glomerulonephritis (MPGN) pattern on light microscopy with “full house” on immunofluorescence consistent with class IV renal-limited LN. He was treated with steroids and mycophenolate mofetil with remission of proteinuria and improvement in renal function.

Discussion

Our patient met systemic lupus erythematosus (SLE) criteria via 2019 ACR guidelines with positive ANA (1:320 with dual speckled and nuclear pattern) and renal biopsy results. He did not have any other systemic or constitutional findings. Although he had hypocomplementemia and thrombocytopenia, these were not scored due to his liver disease. He had indeterminate anti-dsDNA levels but later became consistently negative with therapy.

Our patient’s rather unique disease course and mixed autoimmune features show the challenges in diagnosis of overlapping AIH and LN. In patients like ours who do not exhibit other systemic signs of SLE, renal biopsy might be the only way to establish diagnosis. Hence, prompt clinical suspicion by the clinician is important in diagnosis and subsequent delivery of treatment. Further case reports will be beneficial in raising awareness of the overlapping of AIH and LN.