Hyperacute renal failure as the initial presentation of systemic lupus erythematosus

Abstract

SLE nephritis is usually a slow process that may lead to renal failure many years after its first presentation. Success of different therapeutic modalities in preventing renal failure is therefore evaluated and compared only after many years of treatment. Lately, this conservative philosophy has been challenged with the acknowledgment of collapsing glomerulopathy (CG), a recent recognized clinical-pathological entity, characterized by rapidly progressive renal failure. Despite this ominous description we present an unusual case of a patient who presented with systemic lupus erythematosus (SLE) and clinical and pathological findings of CG, who completely remitted several weeks after commencing immunosuppressive therapy with intravenous cyclophosphamide and prednisolone.

Keywords

acute renal failure collapsing glomerulopathy cyclophosphamide nephritic syndrome systemic lupus nephritis

Get full access to this article

View all access options for this article.

References

Coggins CH , McCluskey RT. Case records of the Massachusetts general hospital - rapidly progressive renal failure in a 35-year-old woman with systemic lupus erythematosus . New Engl J Med 2001; 344: 1154-1157 .

Cameron JS. Lupus nephritis . J Am Soc Nephrol 1999; 10: 413-424 .

Appel GB , Silva FG , Pirani CL , Meltzer JI. Renal involvement in systemic lupus erythematosus (SLE): a study of 56 patients emphasizing histologic classification . Medicine (Baltimore) 1978; 57: 371-410 .

Weiss MA , Daquioag E , Margolin EG , Pollak VE. Nephrotic syndrome, progressive irreversible renal failure, and glomerular ‘collapse’: a new clinicopathologic entity ? Am J Kidney Dis 1986; 7: 20-28 .

Laurinavicus A , Rennke HG. Collapsing glomerulopathy - a new pattern of renal injury . Semin Diagn Pathol 2002; 19: 106-115 .

Korbet SM , Schwartz MM , Lewis EJ. Primary focal segmental glomerulosclerosis: clinical course and response to therapy . Am J Kidney Dis 1994; 23: 773-783 .

Avila-Casado MC. Collapsing glomerulopathy: a new entity with nephrotic syndrome and end-stage renal failure . Rev Invest Clin 1999; 51: 367-373 .

Haas M , Spargo BH , Coventry S. Incidence of focal-segmental glomerulosclerosis among adult nephropathies: a 20-year renal biopsy study . Am J Kidney Dis 1995; 26: 740-750 .

Bariéty J , Nochy D , Mandet C , Jacquot C , Glotz D , Meyrier A. Podocytes undergo phenotypic changes and express macrophagic-associated markers in idiopathic collapsing glomerulopathy . Kidney Int 1998; 53: 918-925 .

10.

Gibson IW , More IA. Glomerular pathology: recent advances . J Pathol 1998; 184: 123-129 .

11.

Laurinavicius A , Hurwitz S , Rennke HG. Collapsing glomerulopathy in HIV and non-HIV patients: a clinicopathological and follow-up study . Kidney Int 1999; 56: 2203-2213 .