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Case Reports
. 2019 Aug 27;20(1):334.
doi: 10.1186/s12882-019-1531-7.

Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?

Marie Lemerle  1   2 , Anne-Sophie Garnier  1   2 , Anne Croue  3 , Alain Chevailler  4 , Jean-Paul Saint-André  2   4 , Jean-François Subra  1   2 , Jean-François Augusto  1   2 , Julien Demiselle  5   6
Affiliations
Case Reports

Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?

Marie Lemerle et al. BMC Nephrol. .

Abstract

Background: The value of ANCA positivity in the setting of systemic lupus erythematous and their pathogenicity remains uncertain.

Case presentation: We report the case of a 48-year-old female with rapidly progressive kidney failure, arthro-myalgia and weight loss. Auto-immune screening showed anti-dsDNA antibodies, complement consumption and triple ANCA positivity. A first kidney biopsy done at presentation highlighted class IV-G glomerulonephritis with elective extra-capillary involvement and mainly C1q glomerular deposition at immunofluorescence study. After three months of a regimen combining steroids and cyclophosphamide, a second biopsy was performed and showed class IV-G glomerulonephritis with mainly endocapillary proliferation.

Conclusion: This case is atypical in view of immunological profile and kidney histopathological presentation and evolution and gives rise to discussion in view of recent data on ANCA value in lupus nephritis, and suggests that different auto-immune pathways may be involved in lupus nephritis.

Keywords: ANCA; Immunology; Lupus glomerulonephritis.

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Conflict of interest statement

All the authors declare to have no competing interest.

Figures

Fig. 1
Fig. 1
Kidney biopsy done at admission. (a,b) Light microscopy examination showing (a) cellular circumferential crescents within 3 glomeruli, and (b) a normal glomeruli. Periodic acid-Schiff staining. (c, d, e), Immunofluorescence analysis showing predominant C1q staining (d), as compared to IgG (c) and C3 (e) staining
Fig. 2
Fig. 2
Control kidney biopsy done at month 4 from admission. (a,b) Light microscopy examination showing (a) diffuse endocapillary proliferation in 2 glomeruli, and (b) fibrotic crescents in 2 glomeruli. Periodic acid-Schiff staining staining. (c, d, e), Immunofluorescence analysis showing predominant C1q staining (d), as compared to IgG (c) and C3 (e) staining
See this image and copyright information in PMC

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