MASSIVE UNCOMPLICATED VASCULAR IMMUNE-COMPLEX DEPOSITS IN THE KIDNEY OF A PATIENT WITH SYSTEMIC LUPUS-ERYTHEMATOSUS

The case of a patient with systemic lupus erythematosus (SLE) is repor ted which was accompanied by renal dysfunction and massive vascular im mune deposits in the kidney without active glomerular lesions. The ren al biopsy showed arterioles and small arteries with circumferential pe riodic acid-Schiff (PAS) and Masson trichrome-positive homogenous mate rial in the subendothelial area in the absence of thrombotic, necrotiz ing or inflammatory lesions, Immunofluorescence and electron microscop y examination demonstrated immune deposits in the vascular walls. Glom eruli showed only minor abnormalities with a trend to collapse. There was no improvement in renal dysfunction over a 4-year period until the patient's death, despite steroid therapy producing a decrease in dise ase activity. The autopsy showed similar vascular changes to those see n in the biopsy, however; glomeruli were either sclerotic or showed a trend to collapse. Massive uncomplicated vascular immune complex depos ition without active glomerular lesions is rare. The present case indi cates that this type of lupus vasculopathy may be a prognostic factor for the loss of renal function in SLE mediated by hemodynamic glomerul ar injury.