title: Pediatric lupus nephritis presenting with terminal renal failure.
abstract: A 12-year-old Congolese girl presented with acute renal failure, edema, hypertension, hemoptysis, hematuria, and proteinuria after a history of throat infection. Renal ultrasound showed kidneys of normal size, with increased echogenicity of the cortical parenchyma and decreased corticomedullary differentiation. Other additional investigations showed pancytopenia with decreased complement (low C3 and C4). Antinuclear antibodies were strongly positive, including anti-double stranded DNA. Renal biopsy confirmed severe grade IV lupus nephritis. She was treated with high-dose steroids, mycophenolate mofetil and hydroxychloroquine, in addition to hemodialysis. After one week of intensive treatment, diuresis recovered and dialysis could be stopped after six sessions. We describe an uncommon case of severe lupus nephritis, presenting with terminal renal failure. Since the rarity of this disease presentation, other more common diagnoses have to be considered. Once the diagnosis of lupus nephritis is established, a choice has to be made between the different induction treatment protocols. The patient's ethnic background and other supportive therapies, such as the need for dialysis, can help to make this choice.
authors.affiliation: a Department of Pediatric Nephrology , University Hospital Ghent , Belgium.
authors.forename: Martine T P
authors.initials: MT
authors.lastname: Besouw
authors.affiliation: a Department of Pediatric Nephrology , University Hospital Ghent , Belgium.
authors.forename: Johan G
authors.initials: JG
authors.lastname: Vande Walle
authors.affiliation: a Department of Pediatric Nephrology , University Hospital Ghent , Belgium.|b Department of Pediatrics , Hospital Universiti Sains Malaysia , Malaysia.
authors.forename: Mohamad I
authors.initials: MI
authors.lastname: Ilias
authors.affiliation: a Department of Pediatric Nephrology , University Hospital Ghent , Belgium.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Raes
authors.affiliation: a Department of Pediatric Nephrology , University Hospital Ghent , Belgium.
authors.forename: Agnieszka A
authors.initials: AA
authors.lastname: Prytula
authors.affiliation: c Department of Pediatrics , Emmaus - Sint-Jozef Hospital , Malle , Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Claeys
authors.affiliation: a Department of Pediatric Nephrology , University Hospital Ghent , Belgium.
authors.forename: Jo L
authors.initials: JL
authors.lastname: Dehoorne
mesh_terms: D001706:Biopsy; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology*; D008181:Lupus Nephritis / Q000150:complications* / Q000175:diagnosis; D014463:Ultrasonography
keywords: Acute renal failure; Dialysis; Differential diagnosis; Lupus nephritis; Systemic lupus erythematosus; Terminal renal failure