An Antinuclear Antibody-Negative Patient With Lupus Nephritis

Kim, Hyoun‐Ah; Chung, Jae-Wook; Park, Han-Jung; Joe, Dai-Yeol; Yim, Hyunee; Park, Hae‐Sim; Suh, Chang‐Hee

doi:10.3904/kjim.2009.24.1.76

Cited by 27 publications

(21 citation statements)

References 14 publications

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“…Immunofluorescence (IF) is characteristic for the presence of the 3 classes of immunoglobulins (IgG, IgM, IgA) and classic and alternative complement pathway deposits (C3, C4, C1q) [1,7,16,[18][19][20] . Because of the widespread potential derangements, a renal biopsy is critical to making the clinical diagnosis, as the pattern of LN injury identified often dictates treatment course and prognosis.…”

Section: Introductionmentioning

confidence: 99%

Antinuclear Antibody-Negative Lupus Nephritis with Full House Nephropathy: A Case Report and Review of the Literature

Simmons¹,

Smith²,

Chang-Miller

et al. 2015

Am J Nephrol

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Lupus nephritis (LN) is a serious and common complication of systemic lupus erythematosus (SLE) that predisposes to significant morbidity and mortality. Studies show that prompt diagnosis and treatment improves patient survival. We present a case of a 49-year-old female with an atypical presentation of LN who initially presented with new-onset hypertension, edema, arthritis, serositis and recently diagnosed leukocytoclastic vasculitis who later developed acute kidney injury, hematuria and nephrotic syndrome. Laboratory testing showed mixed cryoglobulinemia and elevated perinuclear anti-neutrophil cytoplasmic (p-ANCA) and myeloperoxidase (MPO) antibodies. SLE-related serologies were negative. Kidney biopsy showed diffuse proliferative global glomerulonephritis with a full-house nephropathy pattern on immunofluorescence suggestive of LN. Due to high clinical suspicion and renal biopsy findings, she was treated for LN with prompt renal response to immunosuppression. Cryoglobulins, p-ANCA and MPO titers normalized and the negative SLE serologies remained negative. Literature review on antinuclear antibody (ANA)-negative and seronegative LN revealed the following patient presentations: (1) renal-limited or renal and extra-renal manifestations of SLE with negative serologies and (2) renal and extra-renal manifestations of SLE with negative serologies at presentation who develop positive serologies later in follow-up. Both groups represent a unique and challenging cohort of patients who may require longer follow-up and further testing to rule out other glomerular diseases that may mimic LN on renal biopsy. The absence of SLE-related serologies should be weighed against a high pre-test probability of ANA-negative or seronegative LN. If highly suspected, the patient should be treated promptly with close monitoring.

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Section: Introductionmentioning

confidence: 99%

Antinuclear Antibody-Negative Lupus Nephritis with Full House Nephropathy: A Case Report and Review of the Literature

Simmons¹,

Smith²,

Chang-Miller

et al. 2015

Am J Nephrol

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“…There are reported cases of ANA negative patients, one study from korea observed the Lupus nephritis patient with ANA negativity. [15] …”

Section: Resultsmentioning

confidence: 99%

Study on Clinical Manifestations of SLE and its Anti-Nuclear Antibodies Profile

Madhav¹

2017

Ann. Int. Med. Den.Res.

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Background: SLE clinical manifestations and course are highly variable, ranging from indolent to fulminant by the production of antibodies to cell nucleus components and also towards cytoplasmic antigens. Autoantibodies helps to diagnose SLE appropriately. The present study is undertaken to know the varied clinical features of SLE prevalence and also to know the ANA profile in relation to SLE. Methods: All the patients were examined and advised to undergo an ANA profile diagnostic checkup by ELISA. ANA autoantibodies tested were anti dsDNA, anti-Nucleosome, anti-Histone, anti nRNP (Ribonucleoprotein), anti Sm (Smith), anti La, anti RO-52. ANA profile data was collected and also clinical features of SLE was noted. Collected data was analyzed and represented in the form of percentages. Results: Among these most predominant feature was oral lesions, was 87.5% and joint pains, was 82.8% followed by Hair loss (78.1%), fever (71.8%). Anti dsDNA antibodies were reported in 78.1% which were the most commonest autoantibodies. Among other autoantibodies, anti-histone anti-nucleosome were reported predominantly with percentages 56.2% and 29.6% respectively. Conclusion: Need a good diagnostic methods for confirmation of SLE and to start accurate treatment and also to assess the prognosis of SLE. Among various diagnostic methods analyzing ANA profile helps to confirm the diagnosis with good accuracy.

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“…This finding was significantly higher than in previously published reports (2-3%). 19,20 An increased number of ANA negative patients can be explained by the technical inaccuracy in laboratories, too low levels of ANA in patient's serum, and by binding ANA in the form of immune complex. 20 The serum level of complements are found to be decreased in active disease, and is often improved with treatment in SLE.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 An increased number of ANA negative patients can be explained by the technical inaccuracy in laboratories, too low levels of ANA in patient's serum, and by binding ANA in the form of immune complex. 20 The serum level of complements are found to be decreased in active disease, and is often improved with treatment in SLE. Twenty percent of the SLE patients were of families in which one first-degree relative had lupus, probably due to the high consanguinity in the Iranian population.…”

Section: Discussionmentioning

confidence: 99%