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Case Report

Re-Occurring Proteinuria in a SLE Patient: Always Lupus Nephritis?

Henk A. Martens1*, Marc Bijl2, Marius C. Van den Heuvel3 and Cees G.M. Kallenberg4

1Department of Rheumatology, Sint Maartenskliniek Nijmegen, Netherlands

2Department of Rheumatology and Clinical Immunology, Martini Hospital Groningen, Netherlands

3Department of Pathology, Medisch Centrum Leeuwarden, Netherlands

4Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Netherlands

*Corresponding Author:
Henk A. Martens
Department of Rheumatology
Sint Maartenskliniek, 6500 GM Nijmegen, Netherlands
Tel: + 0031-24-3659278
Fax: + 0031 50 3619308
E-mail: [email protected]

Received Date: April 17, 2017; Accepted Date: May 25, 2017; Published Date: June 05, 2017

Citation: Martens HA, Bijl M, Marius C, Kallenberg CGM (2017) Re-Occurring Proteinuria in a SLE Patient: Always Lupus Nephritis?. Lupus Open Access 2:128.

Copyright: © 2017 Martens HA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Renal disease, designated as lupus nephritis (LN), is one of the severe manifestations of Systemic Lupus Erythematosus (SLE). The proliferative forms require aggressive treatment with corticosteroids and cytotoxic drugs. In a substantial number of patients, renal disease relapses after treatment.
Case report: In this case report, we present a 27-year old woman, who had been treated for a membranoproliferative LN in the past. Seventeen years later she presented with chest pain and nephrotic-range proteinuria and severe hypoalbuminemia. The diagnosis of pulmonary embolism was made. Renal biopsy revealed only minimal abnormalities, confined to the mesangium. There was no glomerulonephritis. Based on this finding and the nephrotic-range proteinuria, the diagnosis of minimal-change disease was made. The patient was treated with prednisolone, after which the proteinuria diminished, but did not disappear. After the addition of azathioprine, the proteinuria resolved completely.
Conclusion: This case illustrates that, although the diagnosis of LN has been made in the past, this does not exclude the occurrence of renal pathology caused by other diseases than SLE. Therefore, a renal biopsy is mandatory in every SLE patient with occurrence of renal abnormality es, even when a history of LN is present.

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