SLE and idiopathic nephrotic syndrome: Coincidence or not?

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SLE and idiopathic nephrotic syndrome: Coincidence or not?

Abstract

Background: The association of systemic lupus erythematosus (SLE) with

minimal change disease (MCD) and/or focal and segmental glomerulosclerosis

(FSGS) has been described in isolated case reports. The relevance of this

association is still debated. Methods: We performed a retrospective and

descriptive study of 11 patients with SLE who experienced idiopathic

nephrotic syndrome (iNS) in an effort to determine the relevance of this

unusual combination. Results: All patients fulfilled at least four criteria

(renal abnormalities excluded) of the American Rheumatologic Association for

the diagnosis of SLE, and all had severe nephrotic syndrome (mean

proteinuria, 9.23 ± 6 g of protein/24 h; serum albumin concentration, 1.48 ±

0.6 g/dL). None had a past medical history of lupus nephritis or a cause for

secondary FSGS. Renal histological examination showed MCD (4 patients) or

FSGS (7 patients) without mesangial proliferation. Immunofluorescence was

negative in 8 patients. In 3 patients, immune deposits (immunoglobulin G,

immunoglobulin M, C3, and C1q) were present, but confined to the mesangium

without glomerular changes on light microscopy. The abrupt onset of

nephrotic syndrome coincided with the appearance of SLE in 6 patients (group

1) and recurrence of SLE in 3 patients (group 2). Two patients in group 1

experienced SLE recurrence with concomitant relapse of nephrotic syndrome.

In only 2 patients (group 3) were the two diseases independent. Conclusion:

These results suggest that a relevant association exists between both

diseases, and SLE could be a precipitating factor for iNS. Am J Kidney Dis

40:1179-1184. © 2002 by the National Kidney Foundation, Inc.