J Korean Rheum Assoc.  2009 Mar;16(1):54-58. 10.4078/jkra.2009.16.1.54.

A Case of IgA Nephropathy Associated with Systemic Lupus Erythematosus

• Bang SY
• Kim GH
• Shin DH
• Park MH
• Jun JB

• KMID: 2202142
• DOI: http://doi.org/10.4078/jkra.2009.16.1.54

Abstract

Renal involvement is frequently seen in patients with systemic lupus erythematosus (SLE). The occurrence of non-lupus nephritis, and especially IgA nephropathy, in SLE patients has rarely been reported. We describe here the case of a 30-year-old woman who had systemic lupus erythematosus and nontuberculous mycobacterial lung disease, and her biopsy of a renal lesion was unexpectedly diagnostic of IgA nephropathy. Although both IgA nephropathy and lupus nephritis are immune complex mediated diseases, their laboratory and histopathologic findings and the extra-renal clinical manifestations are different and these all support a different pathogenesis for the 2 diseases. Renal biopsy plays a crucial role in identifying and diagnosing renal lesions, which may have prognostic and therapeutic implications that are distinct from those of lupus nephritis. In conclusion, performing a renal biopsy in SLE patients who have urinary abnormalities is important since a correct diagnosis would permit the most appropriate treatment to be started and so avoid unnecessary immunosuppressive treatments.

Keyword

IgA nephropathy; Systemic lupus erythematosus; Non-tuberculous mycobacterium

MeSH Terms

Adult
Antigen-Antibody Complex
Biopsy
Female
Glomerulonephritis, IGA
Humans
Immunoglobulin A
Lung Diseases
Lupus Erythematosus, Systemic
Lupus Nephritis
Nephritis
Antigen-Antibody Complex
Immunoglobulin A

Figure

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  Fig. 1. Multifocal infiltrations of non-tuberculosis mycobacterium in both lungs are noted on the chest X-ray.

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  Fig. 2. The mesangium is mildly expanded with proliferations of mesangial cells and expansion of the mesangial matrix. Mild tubular atrophy and interstitial fibrosis are seen (PAS, ×400).

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  Fig. 3. Direct immunofluorescence microscopy demonstrates positive mesangial staining for IgA (A) and C3 (B) (×400).

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  Fig. 4. The electron micrograph demonstrates electron dense deposits in the mesangial and paramesangial areas (×6,000).

Reference

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