CASE STUDIES

European Renal Association – European Dialysis and Transplant Association (ERA-EDTA)
in collaboration with
Renal Pathology Society (RPS)

CME Course on Renal Pathology

December 8th 2003

Milan, Italy

LUPUS NEPHRITIS: CASE PRESENTATION


By G. Moroni

Dr G. Moroni
Padiglione Croff
IRCCS Ospedale Maggiore, Policlinico
Milan, Italy

 

Question 1: What is the probability of having a focal or diffuse proliferative lupus nephritis at renal biopsy (class III or Class IV WHO) in a patient with urinary abnormalities without nephrotic syndrome or renal insufficiency?

Case Presentation

* A 18-year old male was admitted to Policlinico Hospital in November 1980 for evaluation of urinary abnormalities.

* During the 3 months before admission he complained of: arthralgias, intermittent fever and malar rash.

* At presentation a physical examination was unremarkable with exception of the presence of malar rash. Blood pressure was 130/80mmHg and heart rate was 80 beats/min, temperature was 37.5°C.

 

Laboratory tests

White cells count 4,100mm3, Haematocrit 30%, Platelet count 105,000mm3.

Plasma creatinine 0.8mg/dl, Creat. clearance 115 ml/min, Serum protein 6.8g/dl, albumin 3.8g/dl C3 and C4 were low, LE test, anti-DNA antibodies were positive, Lupus anticoagulant was positive.

Urinalysis showed: Proteinuria 0.60g/24h, Red blood cells: 15HPF, White blood cells: 5/HPF, granular and cellular casts.

Question 1