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Open Access Case report

Unexpected recovery from longterm renal failure in severe diffuse proliferative lupus nephritis

Sophia Ross1, Kerstin Benz1*, Katja Sauerstein1, Kerstin Amann2, Jörg Dötsch3 and Katalin Dittrich4

Author Affiliations

1 Department of Pediatric Nephrology, University of Erlangen-Nürnberg, Loschgestr. 15, Erlangen, D-91054, Germany

2 Department of Nephropathology, University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany

3 Department of Pediatrics, University of Köln, Köln, Germany

4 Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany

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BMC Nephrology 2012, 13:81  doi:10.1186/1471-2369-13-81

Published: 6 August 2012

Abstract

Background

Severe renal manifestation of systemic lupus erythematosus (SLE) is not uncommon and is associated with an indeterminate prognosis. Complete remission can be obtained, however, at least in the young when chronic lesions are absent and adequate anti-inflammatory therapy is immediately initiated.

Case presentation

We report the unusual case of a 12-year-old girl who presented with severe oliguric renal failure, macrohematuria and skin rash. Renal biopsy revealed the diagnosis of severe diffuse proliferative glomerulonephritis (GN) with cellular crescents in 15 out of 18 glomeruli and full-house pattern in immunofluorescence indicating lupus nephritis IVB according to WHO, IV-G(A) according to ISN/RPS classification. The serological parameters confirmed the diagnosis of SLE and the patient was immediately treated with methylprednisolone, cyclophosphamide and immunoadsorption. Initially, despite rapid amelioration of her general condition, no substantial improvement of renal function could be achieved and the patient needed hemodialysis treatment for 12 weeks. Unexpectedly, in the further follow-up at first diuresis increased and thereafter also creatinine levels substantially declined so that hemodialysis could be discontinued. Today, 6 years after the initial presentation, the patient has normal renal function and a SLEDAI score of 0 under a continuous immunosuppressive therapy with Mycophenolate mofetil (MMF) and low dose steroid.

Conclusion

Despite the severity of the initial renal injury and the unfavourable renal prognosis the kidney apparently has a tremendous capacity to recover in young patients when the damage is acute and adequate anti-inflammatory therapy is initiated without delay.

Keywords:
Proliferative lupus nephritis; Acute renal failure; Immunosuppressive treatment; Mycophenolate mofetil; Remission