Tuesday, August 14, 2012

CONSULT ROUNDS: Minimal Change and Lupus?

A 34 year old female presents with sudden onset nephrotic syndrome. A kidney biopsy confirms minimal change disease. Subsequently, labs reveal a + ANA and + dsDNA and + anti smith antibody.
Is the glomerular disease secondary to SLE?

Initially described in 2005, lupus associated minimal change disease is also called lupus podocytopathy.

A series of patients SLE and proteinuria were studied to determine whether nephrotic range
proteinuria was associated with diffuse epithelial cell foot process effacement in the absence of peripheral glomerular immune aggregate deposition.  Eighteen biopsies were studied, eight from patients with nephrotic-range proteinuria (>3 g/d) and 10 from patients with nonnephrotic proteinuria. Seven of eight biopsies from nephrotic patients demonstrated at least 80% foot process
effacement, whereas no biopsy from a nonnephrotic patient exhibited >20% effacement. No IF or LM findings were found. Interestingly, no full house pattern was noted as well. The single common morphologic feature associated with nephrotic proteinuria was diffuse visceral epithelial cell foot process effacement. That initially manuscript revealed that this entity is more likely SLE related rather than co existence of SLE and minimal change separately, 
In 2009, a letter to the editor in Rheumatology suggested another case of such matter. 
Subsequently, more cases have been described. 
Of recently, cases of collapsing FSGS is described as a variant of lupus podocytopathy. 

Lupus usually presents with a proliferative manifestation in the kidney but perhaps a podocytic variant might exist. More data is needed in this variant of lupus. 

No comments:

Post a Comment

All Posts

Search This Blog