[A case report of lupus nephritis associated with minimal change nephrotic syndrome--comparison of various histological types of 67 cases with lupus nephritis].
A 22 year old male of lupus nephritis associated with minimal change nephrotic syndrome was described. The patient was well until 4 years earlier, when Raynaud's phenomenon and photosensitivity developed. One week before admission, edema appeared suddenly and proteinuria was pointed out on July 28, 1990. On admission, his legs, ankles, and eyelids were edematous. There was no sclerodactylia, although Raynaud's phenomenon was positive when his hand disclosed to the cold. Urinalysis showed heavy albuminuria (10.4g/day), but urinary sediment showed no abnormality. Immunological examination showed positive antinuclear antibody, determination at a titer of 1: 160 with a speckled pattern. Anti-RNP and anti-Sm antibody were positive. However, neither anti-DNA antibody nor hypocomplementemia was detected. There was high concentration of serum IgE (2564IU/ml). Renal biopsy was performed. Light microscopic study showed slight increase of mesangial cells and matrix. Immunofluorescence study showed mesangial localization of IgG and C3. Electron microscopic study showed electron dense deposits only in the mesangial area. The diagnosis of lupus nephritis associated with minimal change nephrotic syndrome (MCNS) was made and administration of PSL was started. Proteinuria disappeared after 3 weeks and nephrotic syndrome remitted completely. The case of lupus nephritis associated with MCNS is very rare. Therefore, the relationship between amounts of proteinuria and various histological types of 67 cases with lupus nephritis which we experienced at our hospital was evaluated. Results showed that nephrotic range proteinuria was not present in mesangial lupus nephritis. So, it was concluded that if heavy albuminuria was found in mesangial lupus nephritis, we should consider the possibility of lupus nephritis associated with MCNS.
Okai
T
T
First Department of Internal Medicine, Kyorin University.
Soejima
A
A
Suzuki
M
M
Yomogida
S
S
Nakabayashi
K
K
Kitamoto
K
K
Nagasawa
T
T
D000328:Adult; D016516:CD4-CD8 Ratio; D004176:Dipyridamole / Q000008:administration & dosage; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000648:ultrastructure; D008181:Lupus Nephritis / Q000150:complications* / Q000276:immunology / Q000473:pathology; D008297:Male; D009402:Nephrosis, Lipoid / Q000150:complications* / Q000276:immunology / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage
D004176:Dipyridamole; D011239:Prednisolone