Abstract: PUB138
Lupus Podocytopathy: A Case Report of FSGS in a Patient with Lupus
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Byun, Kevin, University of Connecticut School of Medicine, Farmington, Connecticut, United States
- Hadaya, Maha, University of Connecticut School of Medicine, Farmington, Connecticut, United States
Introduction
Lupus podocytopathy is a rare subtype of lupus nephritis in which there is diffuse podocyte effacement without immune complex deposition or with minimal immune complex deposition in the mesangium.
Case Description
A 42-year-old woman with past medical history significant for lupus diagnosed in 2003 and suspected lupus nephritis presented to the emergency department following a witnessed episode of seizure-like activity at home. Her home medications included mycophenolate mofetil 1500mg twice daily, prednisone 10mg daily, and hydroxychloroquine 300mg daily. She was stabilized with leviteracetam 500mg twice daily and was downgraded to the floors. Her physical exam was only significant for bilateral pitting edema. Significant labs include serum creatinine of 2mg/dL with a baseline of 1.2mg/dL, ESR 60 mm/hr, CRP of 9.9mg/dL, c3 of 53mg/dL, C4 of 14mg/dL, dsDNA of > 800IU/mL, and urinalysis showed 300mg/dL of protein with no evidence of hematuria. Prerenal, postrenal, and ATN were ruled out. A renal biopsy was performed and showed focal segmental glomerulosclerosis (FSGS). She was started initially started on solumedrol 500mg three times a day for three days. Solumedrol was tapered on day 4 to 50mg daily for 2 days. She was discharged with a plan to continue tapering and possibly add rituximab. She unfortunately missed multiple appointments. When she followed up with the nephrology clinic, there was a question of medication adherence. Urinalysis at this time showed 300mg/dL and trace amounts of Hb.
Discussion
We present a case in which a patient with lupus was found to have FSGS. We concluded that this patient had lupus podocytopathy and as a result of active lupus. She was treated for FSGS secondary to a lupus flare. Unfortunately, she was lost to follow up and her medication adherence was dubious.