Acute Renal Failure Associated with a Minimal Change Nephrotic Syndrome in a Systemic Lupus Erythematosus Patient

Seo, Dong Bum; Lee, Seoung Woo; Song, Joon Ho; Lee, Kyong Joo; Han, Jee Young; Kim, Moon Jae

doi:10.3349/ymj.2002.43.1.114

Cited by 15 publications

(6 citation statements)

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“…Most patients with lupus podocytopathy present with nephrotic syndrome, some patients also display acute kidney injury. [21][22][23] The treatment regimen for lupus podocytopathy reported in the literature is similar to that used for primary MCD or FSGS, with glucocorticoids being the most widely prescribed agents. Recently, clinical practice guidelines for lupus nephritis have recommended glucocorticoid monotherapy or glucocorticoid plus immunosuppressant therapy for the treatment of lupus podocytopathy with nephrotic syndrome.…”

Section: Introductionmentioning

confidence: 99%

Glucocorticoid with or without additional immunosuppressant therapy for patients with lupus podocytopathy: a retrospective single-center study

Chen

Bao

et al. 2015

Lupus

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Lupus podocytopathy is a newly recognized class of lupus nephritis characterized by extensive glomerular foot process effacement without capillary wall immune deposits. The treatment response and relapse of glucocorticoid with or without additional immunosuppressive agents has not been well investigated. In this study, 50 patients with lupus podocytopathy were included and received glucocorticoid alone (glucocorticoid monotherapy) or glucocorticoid plus additional immunosuppressive agents (combination therapy) for their induction or maintenance treatment regimens. The treatment response and relapse rate in the two groups were respectively analyzed. We found that the induction treatment with glucocorticoid monotherapy and combination therapy led to remission in 47 patients (94.0%) at 12 weeks treatment, with complete remission (CR) occurring in 38 patients (76.0%). The CR rate compared between glucocorticoid monotherapy and combination therapy showed no difference (76.7% vs 75.0%, p = 0.9), the median time to CR was four weeks (range: 2.0-6.0 weeks) in glucocorticoid monotherapy and 8.0 weeks (range: 3.7-12.0 weeks) in combination therapy (p = 0.076). Twenty-seven of 47 patients (57.4%) relapsed during maintenance, the relapse rate was much higher in the glucocorticoid monotherapy group than in the combination therapy group (89.5% vs 35.7%, p < 0.001), regardless of the induction regimens being glucocorticoid monotherapy or combination therapy. No patient developed end stage renal disease or died during follow-up for 6-125 months (median 62 months). In conclusion, the remission of lupus podocytopathy could be induced by glucocorticoid monotherapy or glucocorticoid plus other immunosuppressive agents, while the remission should be maintained by the combination regimen.

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Section: Introductionmentioning

confidence: 99%

Glucocorticoid with or without additional immunosuppressant therapy for patients with lupus podocytopathy: a retrospective single-center study

Chen

Bao

et al. 2015

Lupus

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“…First, lupus podocytopathy patients present with a high incidence of AKI without overt hematuria. The incidence of AKI in lupus podocytopathy patients was reported to be as high as 57% (8,29,30). Overall, 34% of the patients in this study were found to have AKI, and among them only a small proportion showed mild microscopic hematuria.…”

Section: Discussionmentioning

confidence: 99%

Clinical–Morphological Features and Outcomes of Lupus Podocytopathy

Chen

Wang

et al. 2016

Clinical Journal of the American Society of Nephrology

113

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Background and objectives Lupus podocytopathy, which is characterized by diffuse foot process effacement without peripheral capillary wall immune deposits and glomerular proliferation, has been described in SLE patients with nephrotic syndrome in case reports and small series. This study aimed to better characterize the incidence, clinical-morphologic features, and outcomes of such patients from a large Chinese cohort.Design, setting, participants, & measurements Lupus podocytopathy was identified from 3750 biopsies of SLE patients obtained from 2000 to 2013 that showed mild glomerular histology in patients with a clinical sign of nephrotic syndrome. The biopsy results were divided into three groups: glomerular minimal change, mesangial proliferation, and FSGS.Results Fifty (1.33%) cases were identified as lupus podocytopathy and included minimal change in 13 cases, mesangial proliferation in 28 cases, and FSGS in nine cases. Extensive foot process effacement appeared in all the biopsies and mesangial electron-dense deposits were present in 47 biopsies. All patients demonstrated nephrotic syndrome, and the median proteinuria was 5.72 g/24 h (interquartile range [IQR], 3.82, 6.92). Seventeen (34%) cases presented with AKI. Forty-seven (94%) patients achieved remission after immunosuppressive therapy for a median time of 4 weeks (IQR,2,8). Compared with the patients with minimal change and mesangial proliferation, patients with FSGS showed significantly higher incidence of AKI and severe tubule-interstitial injury and a much lower complete remission rate. During follow-up of a median of 62 (IQR, 36, 84) months, renal relapses occurred in 28 (59.6%) patients. No patient died or developed ESRD. ConclusionsThe findings from this cohort study suggest that lupus podocytopathy may represent a special entity of lupus nephritis with distinct clinical-morphologic features. The differences in AKI incidence, tubular injury severity, and response to treatment between the patients with minimal change/mesangial proliferation and those with FSGS patterns indicate two different subtypes of lupus podocytopathy.

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“…Acute renal failure (ARF) in the setting of minimal change disease occurs in one-quarter of such patients. Lupus podocytopathy has also been reported as a complication of ARF [20], and nephrotic lupus podocytopathy elevated serum creatinine compared with non-nephrotic lupus podocytopathy [3]. The pathophysiological basis of ARF in minimal change disease is not understood.…”

Section: Discussionmentioning

confidence: 98%

Accelerated recovery from nephrotic syndrome with acute renal failure by double filtration plasmapheresis in a patient with lupus podocytopathy

et al. 2012

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We describe a case of an adult female who presented with nephrotic syndrome. She was diagnosed with systemic lupus erythematosus with serum antinuclear antibodies, leucopenia with lymphopenia, butterfly erythema, and nephrotic syndrome. Renal biopsy revealed normal glomeruli with diffuse effacement of the foot processes, consistent with lupus podocytopathy. Although human albumin replacement was performed initially, acute renal failure developed rapidly. Therefore, she was treated with double filtration plasmapheresis (DFPP) in addition to oral steroid. After steroid therapy combined with DFPP, the renal function and proteinuria improved rapidly. Although the impact of DFPP on the treatment of lupus nephritis remains to be delineated, our observations suggest that DFPP in lupus podocytopathy played a pivotal role in facilitating the early recovery from renal injuries. Because of the rapid improvement of renal function without any change in body weight by DFPP, acute renal failure in the setting of lupus podocytopathy might contribute to an alternative pathophysiological factor for the diminished glomerular filtration rate, similar to that observed in the setting of idiopathic minimal change glomerulopathy.

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Acute Renal Failure Associated with a Minimal Change Nephrotic Syndrome in a Systemic Lupus Erythematosus Patient

Cited by 15 publications

References 0 publications

Glucocorticoid with or without additional immunosuppressant therapy for patients with lupus podocytopathy: a retrospective single-center study

Glucocorticoid with or without additional immunosuppressant therapy for patients with lupus podocytopathy: a retrospective single-center study

Clinical–Morphological Features and Outcomes of Lupus Podocytopathy

Accelerated recovery from nephrotic syndrome with acute renal failure by double filtration plasmapheresis in a patient with lupus podocytopathy

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