Delayed onset of systemic lupus erythematosus in patients with "full-house" nephropathy

Three patients are described who presented with a glomerulopathy suggestive of lupus nephritis in the absence of other clinical and biological evidenc e of systemic lupus erythematosus (SLE). Renal biopsies showed a "full-hous e" immunofluorescence pattern and two patients also had cytoplasmic tubulor eticular inclusions by electron microscopy. All these patients developed an tinuclear and anti-double-stranded DNA antibodies 3, 5, and 10 years after their original presentation. Subsequently, 1 patient also developed clinica l symptoms of lupus. Reviewing all renal biopsies performed in our departme nt, we found 14 additional patients who presented with a "full-house" immun ofluorescence glomerulonephritis in the absence of other features of SLE. A fter a mean follow-up of 5.8 years, these patients have not developed serol ogical or clinical evidence of SLE. We conclude that a "full-house" glomeru lopathy in children may be the first symptom of SLE, especially when cytopl asmic tubuloreticular inclusions are detected. The appearance of other clin ical and biological symptoms may be delayed by several years.