J Korean Rheum Assoc.  2010 Sep;17(3):316-320.

A Case of Systemic Lupus Erythematosus Involving the Kidneys in a Patient with IgA Nephropathy

• Song JE
• Jang MY
• Oh WG
• Kim JG
• Park SH
• Kim KH
• Hwang MH

Abstract

Renal involvement in systemic lupus erythematosus (SLE) is a typical manifestation of the disease. The occurrence of non-lupus nephritis, especially IgA nephropathy (IgAN), in patients with SLE has rarely been reported. We describe the case of a 21-year-old woman who was diagnosed with IgAN and subacute necrotizing lymphadenitis, and her renal lesion biopsy was typical of lupus nephritis (ISN/RPS Class III). Although IgAN and lupus nephritis share some common physiopathological characteristics, their laboratory, histopathologic findings, and the extra-renal clinical manifestations are different and support a different pathogenesis. Our case highlights the importance of a renal biopsy in patients with lupus and urinary alterations despite underlying IgAN. A correct diagnosis would permit the most appropriate immunosuppressive treatments to be considered.

Keyword

Systemic lupus erythematosus; Lupus nephritis; IgA nephropathy; Subacute necrotizing lymphadenitis

MeSH Terms

Biopsy
Female
Glomerulonephritis, IGA
Humans
Immunoglobulin A
Kidney
Lupus Erythematosus, Systemic
Lupus Nephritis
Lymphadenitis
Nephritis
Young Adult
Immunoglobulin A

Figure

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  Fig. 1. Light microscopic examination revealed that the glomerulus was within normal limits in its size and segmental sclerotic formation (hematoxylin and eosin stain, ×200).

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  Fig. 2. Direct immunofluorescence microscopy is positive for mesangial IgA staining (×400).

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  Fig. 3. Electron microscopic examination shows small amounts of mesangial deposits with many scattered subendothelial deposits (×3,000).

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