Predominant tubulointerstitial nephritis in a patient with systemic lupus nephritis

Abstract

In most cases of systemic lupus erythematosus (SLE), glomerular lesions are the main renal complication. Although tubulointerstitial lesions are often associated with severe glomerular lesions, predominant or isolated tubulointerstitial injury in the presence of minimal glomerular abnormalities with SLE, so-called predominant tubulointerstitial lupus nephritis, is rare. Only ten cases are reported in the English literature. Herein, we describe the case of a 64-year-old man with SLE who presented with acute renal deterioration attributable to acute tubulointerstitial nephritis. Renal biopsy showed diffuse infiltration of inflammatory mononuclear cells in the interstitium and tubulitis without significant glomerular lesions. Immunofluorescence study revealed positive staining for IgG, C3, and C1q along the renal tubular basement membrane (TBM). Electron microscopy also showed electron-dense deposits in the TBM. Other causes of tubulointerstitial injury, such as drug use and infection, were ruled out. Taking these findings together with the presence of antitubular basement membrane antibody, predominant tubulointerstitial lupus nephritis was diagnosed. Treatment with oral corticosteroids for 6 weeks improved renal function. Even after tapering of the corticosteroid, renal function and serological markers of SLE activity have remained stable in this patient for more than 12 months.

Successful Detection of Renal Involvement in Sjögren's Syndrome Secondary to Systemic Lupus Erythematosus by Renal Biopsy

“…While SLE patients can have predominant tubulointerstitial lupus nephritis, characterized by predominant or isolated tubulointerstitial renal damage and minimal glomerular abnormalities, it is quite rare (3). To our knowledge, only 13 cases of predominant tubulointerstitial lupus nephritis have been reported in the English literature (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). We herein describe the case of an 80-year-old man who had a mild renal dysfunction with increased antidsDNA antibody levels.…”

Possible IgG4-Related Kidney Disease Requiring a Differential Diagnosis of Membranous Lupus Nephritis

“…However, in systemic lupus erythematosus, some cases show severe tubulointerstitial nephritis with minimal glomerular changes or mild mesangial proliferation (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), although rare. To date, 12 cases have been reported.…”

Ultrastructural Studies of IgG4-related Kidney Disease

“…For example, Saeki (3), Kawano (13) and Yoshita (14) et al each evaluated at least 20 patients with IgG4-RKD in their series using histological evaluations of light and immunohistochemical modalities without electron microscopy. To date, observations with electron microscopy have been restricted to limited case reports (1,2,6,7,(15)(16)(17). Recently Yamaguchi et al (18) comprehensively reported the ultrastructural findings of 10 cases.…”