An Unusual Case of Crescentic Lupus Nephritis Presenting With Normal Renal Function

Abstract

Lupus nephritis is a life-threatening manifestation of systemic lupus erythematosus (SLE). This is commonly suspected when lupus patients present with elevated serum creatinine levels. But it is important to be aware that even patients with advanced disease in the kidney from SLE can have normal renal function, thus requiring a high index of suspicion. We present the case of a patient who presented with nonspecific musculoskeletal symptoms and was diagnosed with SLE. He also had nephrotic range proteinuria but his serum creatinine was normal. A renal biopsy revealed diffuse proliferative crescentic lupus nephritis. We have reviewed the literature for correlation between crescents; a sign of severe glomerular damage and creatinine levels.

Unusual cases of crescentic glomerulonephritis with normal renal function at diagnosis: a retrospective case series from a single center in Western China

“…Contrary to popular belief, even though crescentic glomerulonephritis is the most severe form of renal disease it may not manifest as rapidly loss of renal function. Normal renal function and minor urinary abnormality does not necessarily rule out this entity 9,[11][12][13][14]19 . Any urinary abnormalities in these patients have to be addressed and managed expeditiously.…”

“…A review of the literature for the prevalence and the possible reasons of the normal renal function in this clinical setting are compared in our research as shown in Table 4. Hironari Hanaoka [14] Chwee Ang [13] Vibhanshu Gupta [12] Sandhya Manohar [11] This paper Adapted from…”

“…A number of retrospective studies have veri ed the e cacy of therapeutic agents for generalized Crescentic GN with renal failure [2][3][4][5][6][7][8] . To our knowledge, however, data concerning the features and management in Crescentic GN with normal renal function is limited, only occasional reports of individuals either as individual cases or within case series are available 9,[11][12][13][14] , and none have conducted a sub-analysis focusing on comparison with impaired renal function.…”

Systemic Lupus Erythematosus (SLE) with Lupus Nephritis in a 15 Year-Old Male – A Case Report

“…SLE complicated with nephritis is more frequent in men than women, and several groups identified male gender as a risk factor for progression to renal failure. [3,11,12] Nephritis has been reported to afflict 27-45% of patients with SLE. Approximately 10-30% of the patients' progress to end-stage renal disease and despite improvements in overall care, long-term mortality remains high.…”

“…[1,5,7,14] Lupus nephritis is classified based on the renal histology findings. [11] International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification of lupus nephritis consists of class I is defined as minimal mesangial lupus nephritis with mesangial accumulation of immune complexes identified by immunofluorescence, or by immunofluorescence and electron microscopy, without concomitant light microscopic alterations. Class II is defined as mesangial proliferative lupus nephritis characterized by any degree of mesangial hyper cellularity (defined as three or more mesangial cells per mesangial area in a 3-micron thick section) in association with mesangial immune deposits.…”