SHM Converge Scientific Abstract ePoster Gallery-Stage Iv Diffuse Proliferative Lupus Nephritis With Normal Complement Levels

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This case describes a 39-year-old woman with systemic lupus erythematosus (SLE) who initially presented with worsening chest pain, dyspnea, fever, and constitutional symptoms. Workup showed sinus tachycardia, elevated inflammatory markers, and a moderate pericardial effusion with impending tamponade. She underwent a pericardial window that drained seropurulent fluid, but cultures were negative, and the effusion was ultimately attributed to lupus pericarditis.<br /><br />Her hospital course became more complicated with recurrent fevers, musculoskeletal pain, intermittent encephalopathy, pleural effusions, oral ulcers, and progressive acute kidney injury. Creatinine rose from 0.90 to 5.32, urine output declined markedly, and urinalysis revealed hematuria with nephrotic-range proteinuria. Because of high ferritin, LDH, triglycerides, and soluble IL-2 receptor levels, macrophage activation syndrome/HLH was considered, but bone marrow biopsy and the broader evaluation did not support that diagnosis. Infection, malignancy, and drug toxicity were also excluded.<br /><br />Kidney biopsy confirmed diffuse proliferative lupus nephritis, ISN/RPS class IV, with immune-complex deposition and tubuloreticular inclusions, consistent with severe active lupus nephritis. She was treated with pulse methylprednisolone followed by Euro-Lupus cyclophosphamide and required intermittent hemodialysis for uremic encephalopathy. Her renal function and urine output improved gradually, and creatinine returned to baseline by discharge.<br /><br />Overall, the case highlights that lupus-related acute kidney injury can occur even with normal complement levels and can mimic infection, drug toxicity, or hyperinflammatory syndromes. Early recognition and kidney biopsy were essential for diagnosis and prompt immunosuppressive treatment, leading to recovery.

Asset Subtitle

Hanna Bobinger

Meta Tag

Author List FNU Ekta, Hanna Bobinger, Urshita Sinha

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Acute Kidney Injury

Concept Lupus Nephritis

Concept Diffuse Proliferative Lupus Nephritis

Concept Kidney Biopsy

Distinguished Non-Finalist

Presenter Organization University Hospital - University of South Alabama

Presenting Author Hanna Bobinger

Track Adult

Keywords

systemic lupus erythematosus

lupus nephritis

acute kidney injury

pericardial effusion

cardiac tamponade

diffuse proliferative glomerulonephritis

immune complex deposition

cyclophosphamide therapy

hemodialysis

macrophage activation syndrome

Systemic Lupus Erythematosus

Acute Kidney Injury

Lupus Nephritis

Diffuse Proliferative Lupus Nephritis

Kidney Biopsy