title: A diagnostic dilemma: lupus nephritis or renal polyarteritis nodosa?
abstract: Lupus nephritis and renal polyarteritis nodosa (PAN) are two distinct disorders that rarely overlap. Herein, we describe a patient who was initially diagnosed with lupus nephritis based on her clinical presentation, proteinuria, hematuria, positive anti-nuclear antibody, and a kidney biopsy. A month later, the patient presented with left flank pain and weakness. A CT scan of the abdomen and pelvis showed a perinephric hematoma and the renal arteriogram revealed numerous microaneurysms within the kidney consistent with renal PAN. This case elucidates the diagnostic and management dilemmas that confront physicians taking care of patients with overlapping features of lupus nephritis and renal PAN and also points to the possible role of lupus nephritis in pathogenesis of renal PAN.
authors.affiliation: a Department of Internal Medicine, Division of Nephrology , Louisiana State University Health Sciences Center Shreveport , Shreveport , LA , USA ;
authors.forename: Shashi
authors.initials: S
authors.lastname: Bhushan
authors.affiliation: a Department of Internal Medicine, Division of Nephrology , Louisiana State University Health Sciences Center Shreveport , Shreveport , LA , USA ;
authors.forename: Kenneth
authors.initials: K
authors.lastname: Abreo
authors.affiliation: a Department of Internal Medicine, Division of Nephrology , Louisiana State University Health Sciences Center Shreveport , Shreveport , LA , USA ;
authors.forename: Natalie
authors.initials: N
authors.lastname: Rodziewicz
authors.affiliation: b Department of Pathology , Louisiana State University Health Sciences Center , Shreveport, Shreveport , LA , USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Gu
authors.affiliation: a Department of Internal Medicine, Division of Nephrology , Louisiana State University Health Sciences Center Shreveport , Shreveport , LA , USA ;
authors.forename: Neeraj
authors.initials: N
authors.lastname: Singh
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000328:Adult; D000072226:Computed Tomography Angiography; D003951:Diagnostic Errors; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D008181:Lupus Nephritis / Q000175:diagnosis; D008854:Microscopy, Electron; D010388:Pelvis / Q000000981:diagnostic imaging; D010488:Polyarteritis Nodosa / Q000000981:diagnostic imaging*; D011507:Proteinuria / Q000209:etiology; D012077:Renal Artery / Q000000981:diagnostic imaging*
keywords: Lupus nephritis; polyarteritis nodosa; systemic lupus erythematous