Pauci-immune rapidly progressive glomerulonephritis in a patient with systemic lupus erythematosus
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Abstract
Introduction: rapidly progressive glomerulonephritis is a nephrological emergency. Histological findings are usually characterized by the presence of crescentic glomerulonephritis with immune deposits and endocapillary proliferation. On the contrary, the absence of immune deposits is associated to a greater extent with vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCAs)
Case report: a 21-year-old patient with a history of systemic lupus erythematosus presented increased creatinine, active urinary sediment, and decreased serum complement levels. A renal biopsy was performed, revealing pauci-immune crescentic glomerulonephritis, without endocapillary proliferation. Serology for ANCA was positive.
Discussion: the patient of this case presented unexpected findings in the renal biopsy; positive ANCA serology confirmed that the glomerulonephritis was mediated by ANCA and not by immune deposits. Pauci-immune glomerulonephritis in patients with systemic lupus erythematosus is a rare finding, whose estimated prevalence is only 2 %.
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