Abstract: SA-PO0801
When Immune Complexes Meet Crystals: A Case of Lupus Nephritis Unveiling Gouty Nephropathy
Session Information
- Glomerular Diseases: Lupus Nephritis, Monoclonal Gammopathy-Related Disease, and Transplantation
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Shahid, Shahzad, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Khan, Maida, Services Hospital Lahore, Lahore, Punjab, Pakistan
- Arwani, Suneel, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Velagapudi, Ramya Krishna, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Yunas, Samia, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Atari, Mohammad, The University of Mississippi Medical Center, Jackson, Mississippi, United States
Introduction
Lupus nephritis is a major cause of kidney disease in systemic lupus erythematosus, with mixed proliferative and membranous forms linked to poor renal outcomes. Gouty nephropathy from uric acid crystal deposition is rarely identified on renal biopsy. We report a rare case of concurrent lupus nephritis and superimposed gouty nephropathy contributing to severe renal injury.
Case Description
A 38-year-old man with systemic lupus erythematosus, CKD stage 3 (baseline creatinine 1.6–2.0 mg/dL), morbid obesity, hypertension, obstructive sleep apnea, and prior PE/DVT presented with worsening renal failure, nausea, vomiting, poor oral intake, and acute left-hand pain concerning for gout flare. Laboratory evaluation showed creatinine 7.5 mg/dL, BUN 47 mg/dL, nephrotic-range proteinuria (~13 g/24 h), and uric acid 12.8 mg/dL. ANA, anti-dsDNA, ANCA, and anti-Smith antibodies were negative or normal; C3 was normal with low C4. HIV and hepatitis serologies were negative, and renal ultrasound showed no obstruction.
Kidney biopsy demonstrated Class III/V lupus nephritis with acute tubular injury and collapsing glomerulopathy. Uric acid crystal deposition consistent with superimposed gouty nephropathy was also identified.
The patient was treated with pulse intravenous steroids followed by prednisone taper, mycophenolate mofetil, and belimumab. At 3-month follow-up, creatinine improved to ~3.0 mg/dL, with proteinuria decreasing to 2.05 g/day.
Discussion
This case highlights advanced lupus nephritis with nephrotic-range proteinuria and superimposed biopsy-proven gouty nephropathy. The coexistence of these entities is rare, while marked hyperuricemia and concurrent gout flare support clinically significant urate burden. Kidney biopsy was essential for diagnosis, and corticosteroid therapy likely improved both lupus nephritis and acute gout inflammation.