SHM Converge Scientific Abstract ePoster Gallery-Unmasking Focal Segmental Glomerulosclerosis in Lupus Nephritis Patient

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This case report describes a 28-year-old Middle Eastern man with systemic lupus erythematosus (SLE) and previously diagnosed lupus nephritis, treated for years with mycophenolate mofetil. During follow-up, he developed worsening kidney function and increasing nephrotic-range proteinuria despite escalation of therapy. Laboratory findings were not suggestive of active lupus flare, with normal complement levels and negative anti–double-stranded DNA and anti-Smith antibodies.<br /><br />Because of the rising proteinuria and creatinine, nephrology was consulted and a repeat kidney biopsy was performed. The biopsy unexpectedly showed focal segmental glomerulosclerosis (FSGS) with no evidence of active lupus nephritis. Based on these findings, mycophenolate mofetil was tapered off and rituximab was started.<br /><br />The report emphasizes that in patients with SLE, nephrotic-range proteinuria is often assumed to represent lupus nephritis, but other renal pathologies such as FSGS can coexist or mimic it. This creates an important diagnostic and therapeutic challenge, since treatment should be guided by biopsy rather than clinical suspicion alone. The authors stress the value of repeat renal biopsy when kidney disease worsens or fails to respond to standard lupus nephritis therapy.<br /><br />Overall, the case highlights the need for close collaboration between rheumatologists and nephrologists and supports a more individualized approach to renal disease in SLE.

Asset Subtitle

Talar Acob

Meta Tag

Author List Knkush Hakobyan, Sajina Prabhakaran, Talar Acob

Category Clinical Vignettes

Concept Nephrotic-Range Proteinuria

Concept Lupus Nephritis

Concept Kidney Biopsy

Concept Systemic Lupus Erythematosus

Concept Focal segmental glomerulosclerosis

Distinguished Non-Finalist

Presenter Organization Capital Health

Presenting Author Talar Acob

Track Adult

Keywords

systemic lupus erythematosus

lupus nephritis

focal segmental glomerulosclerosis

nephrotic-range proteinuria

kidney biopsy

repeat renal biopsy

mycophenolate mofetil

rituximab

renal pathology

nephrology consultation

Nephrotic-Range Proteinuria

Lupus Nephritis

Kidney Biopsy

Systemic Lupus Erythematosus

Focal segmental glomerulosclerosis