Lupus glomerulitis and renal vein thrombosis.

Abstract

y-globulin. When more fully characterised there is hope that these factors mnay be useful as adjuvants to conventional inimunosuppressive regimens and may find regular application in the protocol for the treatment of severe rejection rather than being used as a "last-ditch" measure.This work was supported by National Heart and Lung Institute Research grants HL 08696 and HL 13108, and US Public Health Service -Research grant RR 70. Occhino, J C, et al,J_ournal of Immunology, 1973, 110, 685. 2 Coulson, A S, et al, Transplantation, 1974, 18, 409. 3 Coulson, A S, and Inman, D R, Guy's Hospital Reports, 1971, 120, 89. 4 Cooperband, S R, et al,J'ournal of Immunology, 1972,109, 154 Case reportA 24-year-old woman was admitted to hospital in January 1975 because of fever, myalgia, and arthralgia of two years' -duration. She had frontal alopecia, splenomegaly, hemolytic anaemia, leucopenia, positive LE cell test, and a C3 of 0-56 g/l (normal 0-9-1-8). SLE was diagnosed. The urine contained protein, occasional red and white blood cells (high power field), and a few granular casts. Serum creatinine was 62 /mol/l (0-7 mgf100 ml), albumin 24 g/l, and cholesterol 3-6 mmol/l (140 mg/100 ml). Creatinine clearance, was 84 ml/min and 24-hour urinary protein excretion was 5 2 g. An intravenous pyelogram showed nothing abnormal. Renal biopsy showed slight mesangial hypercellularity and focal glomerulitis with one haematoxylin body. She was discharged on 20 mg of prednisone and 6 mg of chlorambucil daily.By April, despite restoring the serological abnormalities to normal (negative ANF anti-DNA tests and a C3 of 0-92 g/l), she had oedema up to the thighs. Prednisone was increased to 60 mg/day and she was readmitted. Her serum albumin was 13 g/l, cholesterol 9-2 mmol/l-(355 mg/100 ml), and the urinary protein loss 18-6 g/24 h. The platelet count and coagulogram were normal and no cryoglobulins were found. Renal venography showed a nonocclusive thrombus on the right side (fig). Diuretics were given along with heparin. By May the oedema had gone and the serum albumin had risen to 21 g/l. Protein loss was 9 g/24 h. When last seen in July 1975 she was symptom free, with a serum albumin of 38 g/l and normal serology and creatinine clearance, but she was excreting protein 5 g/24 h. She was receiving warfarin, dipyridamole, prednisone, and chlorambucil. DiscussionThe normal anti-DNA titre and the hypocomplementenaemia at the onset of massive proteinuria in this patient suggests a renal disease other than lupus.2 Unilateral renal vein thrombosis may be associated with the nephrotic syndrome,3 in some cases of which a hypercoagulable state has been identified,4 but the normal coagulogram was against this in our case. There was no evidence of thrombotic thrombocytopenic purpura, intravascular coagulopathy,~~~. Raynaud's phenomenon, macroglobulinaemia, or cryoglobulinaemiaconditions that are associated with SLE and could result in transient or permanent vascular occlusion.The most common glomerular lesion associated with renal vein thr...