SHM Converge Scientific Abstract ePoster Gallery-The Copycat Disease: A Case of Lupus Podocytopathy

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This case describes a 44-year-old woman with a history of trigeminal neuralgia who first presented to the emergency department with 10 days of bilateral lower-extremity edema and abdominal distension. She had no chest pain, shortness of breath, fever, cough, dysuria, or orthopnea. Exam showed mild bilateral ankle pitting edema with otherwise normal cardiopulmonary and abdominal findings. Initial workup revealed marked nephrotic-range proteinuria, hypoalbuminemia (albumin 1.5), elevated BNP, hematuria, and bilateral pleural effusions on CT, leading to a diagnosis of nephrotic syndrome and outpatient nephrology follow-up.<br /><br />Two weeks later, she returned with spasms in her hands and legs and was admitted for worsening acute kidney injury and evaluation for systemic lupus erythematosus (SLE), given a strong family history of lupus on her maternal side. Inpatient renal biopsy showed findings consistent with minimal change disease, including diffuse podocyte foot process effacement on electron microscopy and no immune complex deposition typical of lupus nephritis. Immunofluorescence demonstrated tissue ANA correlating with a positive serum ANA. These findings were interpreted as lupus podocytopathy (LP), a rare lupus-related nephrotic syndrome that can mimic minimal change disease or focal segmental glomerulosclerosis.<br /><br />She was treated with prednisone, bumetanide, and warfarin for thrombosis prophylaxis, then later started on hydroxychloroquine as an outpatient. Her urine protein-to-creatinine ratio improved on follow-up. The case highlights that lupus podocytopathy should be considered in patients with SLE or suspected SLE who present with nephrotic syndrome, since it is uncommon, often steroid-responsive, and may require anticoagulation because of increased thrombotic risk.

Asset Subtitle

Rina Joshi

Meta Tag

Author List John H. Oneill Jr., Maryah Mansoor, Rina Joshi

Category Clinical Vignettes

Concept Nephrotic Syndrome

Concept Lupus Podocytopathy

Concept Proteinuria

Concept Systemic Lupus Erythematosus

Concept Kidney Biopsy

Distinguished Non-Finalist

Presenter Organization Christiana Care

Presenting Author Rina Joshi

Track Adult

Keywords

lupus podocytopathy

nephrotic syndrome

minimal change disease

systemic lupus erythematosus

proteinuria

hypoalbuminemia

acute kidney injury

renal biopsy

podocyte foot process effacement

warfarin anticoagulation

Nephrotic Syndrome

Lupus Podocytopathy

Proteinuria

Systemic Lupus Erythematosus

Kidney Biopsy