Lupus nephritis with cryoglobulinemic glomerulonephritis features: a diagnostic conundrum.

IF 1.1 4区 医学 Q4 MICROSCOPY Ultrastructural Pathology Pub Date : 2023-11-02 Epub Date: 2023-11-30 DOI:10.1080/01913123.2023.2270030
George Terinte-Balcan, Simona Cinca, Simona Stancu, Mihaela Gherghiceanu, Gabriel Stefan
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Abstract

In this clinical case, we report an atypical and unique presentation of systemic lupus erythematosus (SLE) in a 39-year-old female with nephrotic syndrome. The patient exhibited class IV plus V lupus nephritis and extensive immune complex deposition within the intracapillary and arteriolar regions suggestive of cryoglobulinemic glomerulonephritis, despite no detectable circulating cryoglobulins. Electron microscopy revealed cryoglobulin-like deposit distribution in all glomerular examined compartments, namely subendothelial, intramembranous, subepithelial, and mesangial, apparently extending from the capillary hyaline thrombi. The case highlights the possibility of severe renal injury in SLE without circulating cryoglobulins and the diverse kidney manifestations associated with the disease. However, the impact on patient outcome was minimal, as classical treatment (id est National Institute of Health regimen) remained effective.

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狼疮性肾炎伴冷球蛋白血症肾小球肾炎特征:诊断难题。
在这个临床病例中,我们报告了一例39岁的肾病综合征女性系统性红斑狼疮(SLE)的非典型和独特表现。该患者表现为IV级加V级狼疮性肾炎,毛细血管内和小动脉内广泛的免疫复合物沉积,提示冷球蛋白血症性肾小球肾炎,尽管没有检测到循环冷球蛋白。电子显微镜显示,冷冻球蛋白样沉积物分布在所有肾小球检查区,即内皮下、膜内、上皮下和系膜,明显从毛细血管透明血栓延伸。该病例强调了SLE在没有循环冷球蛋白的情况下发生严重肾损伤的可能性,以及与该疾病相关的各种肾脏表现。然而,由于经典治疗(美国国立卫生研究所的方案)仍然有效,对患者结果的影响很小。
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来源期刊
Ultrastructural Pathology
Ultrastructural Pathology 医学-病理学
CiteScore
2.00
自引率
10.00%
发文量
40
审稿时长
6-12 weeks
期刊介绍: Ultrastructural Pathology is the official journal of the Society for Ultrastructural Pathology. Published bimonthly, we are the only journal to be devoted entirely to diagnostic ultrastructural pathology. Ultrastructural Pathology is the ideal journal to publish high-quality research on the following topics: Advances in the uses of electron microscopic and immunohistochemical techniques Correlations of ultrastructural data with light microscopy, histochemistry, immunohistochemistry, biochemistry, cell and tissue culturing, and electron probe analysis Important new, investigative, clinical, and diagnostic EM methods.
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