Ewha Med J.  2013 Sep;36(2):139-143. 10.12771/emj.2013.36.2.139.

Minimal Change Disease in Systemic Lupus: Another Renal Manifestation of Lupus?

• Nam KH
• Cha YJ
• Kwon YE
• Kim YL
• Park KS
• An SY
• Lim BJ
• Jeong HJ
• Oh HJ
• Yoo TH
• Kang SW
• Choi KH
• Han SH

• KMID: 2171249
• DOI: http://doi.org/10.12771/emj.2013.36.2.139

Abstract

Nephrotic syndrome is most commonly observed in membranous lupus nephritis in patients with systemic lupus erythematosus (SLE). However, other forms of idiopathic nephrotic syndrome rarely occur in these patients. Here, we report a case of SLE complicated by minimal change disease (MCD). A 24-year-old woman with SLE visited our hospital for generalized edema and heavy proteinuria. Laboratory tests did not support immunological exacerbation of lupus, while renal biopsy revealed diffusely effaced foot processes without electron-dense deposits that were consistent with MCD. Administration of high-dose corticosteroids and 6 subsequent cycles of monthly intravenous cyclophosphamide resulted in complete remission. Although nephrotic-range proteinuria recurred 1 month after switching to maintenance therapy with mycophenolate mofetil, complete remission was reestablished after a 6-month treatment with corticosteroids and cyclosporine. Physicians should be cautious in assessment and management of such a rare renal manifestation.

Keyword

Lipoid nephrosis; Systemic lupus erythematosus

MeSH Terms

Adrenal Cortex Hormones
Biopsy
Cyclophosphamide
Cyclosporine
Edema
Female
Humans
Lupus Erythematosus, Systemic*
Lupus Nephritis
Mycophenolic Acid
Nephrosis, Lipoid*
Nephrotic Syndrome
Proteinuria
Young Adult
Adrenal Cortex Hormones
Cyclophosphamide
Cyclosporine
Mycophenolic Acid

Figure

• 

  Fig. 1 Pathologic findings. (A) Renal biopsy specimen shows normal glomeruli on light microscopy (original magnification, ×400). (B) Direct immunofluorescence shows weakly positive staining of IgG along the capillary wall. (C) Electron microscopy shows no electron-dense deposits within the glomeruli. Diffusely effaced foot processes are noted.

• 

  Fig. 2 Changes in (A) kidney function and (B) proteinuria during the disease course. PL, prednisolone; CYP, cyclophosphamide; MMF, mycophenolate mofetil; CsA, cyclosporine; S-Cr, serum creatinine; UPCR, urine protein-creatinine ratio.

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