Nephrotic syndrome associated with focal segmental glomerulosclerosis in apatient with systemic lupus erythematosus and membranous glomerulonephritis in remission

Renal involvement is frequent in systemic lupus erythematosus (SLE). This l esion, termed lupus nephritis, has been reported clinically in at least 50% of the patients. It is generally assumed that in patients with SLE, renal abnormalities detected clinically are caused by lupus nephritis, especially lupus glomerulonephritis (GN). Thus, renal biopsy is performed not for dia gnostic purposes, but rather for determining the type and extent of renal i nvolvement. However, clinically significant renal abnormalities unrelated t o lupus nephritis have rarely been described in patients with SLE. The repo rted case serves to emphasize this consideration. The patient was a 41-year -old woman who presented 11 years previously with severe hypertension, neph rotic syndrome, and a serum creatinine level of 2.9 mg/dL. Renal biopsy sho wed membranous GN and ischemic damage. After a prolonged remission induced by steroids and cyclophosphamide, the patient presented with nephrotic synd rome and a serum creatinine level of 2.1 mg/dL. Although she was normotensi ve at that time, there were features of SLE. Repeated renal biopsy showed f ocal segmental glomerulosclerosis without the changes of membranous GN or a ny type lupus GN. This case illustrates two interesting observations, ie, r esolution of membranous ON and nonlupus renal lesions in patients with SLE. (C) 1999 by the National Kidney Foundation, Inc.