Journal List > J Rheum Dis > v.19(5) > 1063992

Park, Kwak, Jung, Koh, Kim, and Suh: Transformation of Recurred Lupus Nephritis from Class IV to Class V

Abstract

There are numerous studies about the transformation of renal pathology during lupus nephritis progression. A number of researchers suggest that patients with previous proliferative glomerulonephritis may not need to repeat renal biopsy in relation to treatment strategies. However, the pathology of renal biopsy could offer important information to clinicians about the progression of disease. Here, we report a rare case of the convertion of ISN/RPS classification from a proliferative lesion to a wholly non-proliferative lesion. A 40-year-old female was admitted complaining of generalized edema for 1 month. At the age of 33 she had been diagnosed as SLE with proliferative lupus nephritis. The renal remission was induced with corticosteroid pulse therapy and 12 cycles of intravenous cyclophosphamide treatment. The repeated renal biopsy revealed class V lupus nephritis compared with referential biopsy of class IV-G. A better prognosis is expected with lower activity and a lower chronicity index. Repeat renal biopsy may give useful information relating to the prognosis of nephritis.

Figures and Tables

Figure 1
Pathologic findings of renal biopsies. (A) First biopsy: The glomerulus shows marked hypercellularity due to mesangial and endocapillary proliferation, and inflammatory cell infiltration. Hyaline thrombi are clearly observed in capillary lumen (H&E, ×400). (B) First biopsy: Electron microscopy image shows electron dense deposits at mesangium and subendothelial layer. (C) Second biopsy: No significant mesangial matrix widening, mesangial cell proliferation and endocapillary wall thickness are shown (H&E, ×400). (D) Second biopsy: Electron dense deposits are observed at mesangium and subepithelial locations along the glomerular basement membranes by electron microscopy.
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Figure 2
Changes of proteinuria according to treatment with cyclophosphamide and mycophenolate mofetil. The renal rebiopsy was performed and proteinuria was improved significantly after 3 cycles of cyclophosphamide and mycophenolate mofetil administration. CYP: cyclophosphamide, MMF: mycophenolate mofetil.
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