The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Systemic Lupus Erythematosus Without Kidney Involvement: A Case Report

Systemic Lupus Erythematosus Without Kidney Involvement: A Case Report

September 15, 2015 • By Paul Hoover, MD, PhD, & Lindsey MacFarlane, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Figure 1: Hematoxylin & Eosin Staining

(Click for larger image)
Figure 1: Hematoxylin & Eosin Staining
Enlarged, hypercellular and lobular-appearing glomeruli; capillary loops are thickened and poorly defined (arrow). The mesangium is moderately expanded by extracellular matrix and increased numbers of mononuclear cells (star).

A 35-year-old female with a history of systemic lupus erythematosus (SLE) without kidney involvement was admitted to our hospital with low-grade fevers, headache, increasing lower extremity edema and elevated blood pressure.

You Might Also Like
  • Case Report: Contagious Rash in Active Systemic Lupus Erythematosus
  • Proptosis in Systemic Lupus Erythematosus
  • Rheumatology Case Report: Bullous Lesions in Patient with Lupus
Explore This Issue
September 2015

History

She was first diagnosed with SLE as a teenager when she developed oral ulcers and pleuritic chest pain and tested positive for anti-Smith and anti-nuclear antibodies (ANAs), meeting four of 11 ACR criteria for SLE. As an adult, her SLE recurred every few years, manifesting as oral ulcers, alopecia, arthritis, biopsy-proven leukocytoclastic vasculitis (LCV) over her lower extremities and hypocomplementemia. She had no prior episodes of nephritis.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Until two months prior to presentation, her symptoms were well controlled with hydroxychloroquine, mycophenolate mofetil (MMF) and low-dose prednisone. However, while transitioning between rheumatologists, she stopped her medications and developed her usual SLE symptoms, including oral ulcers, arthritis and lower extremity rash. In addition, she reported low-grade fevers, headaches, fatigue, pleuritic chest pain, dyspnea on exertion, six-pillow orthopnea and pitting edema in her lower extremities. A physician family member prescribed 60 mg of prednisone daily. Her breathing and chest pain improved, but she continued to experience headaches and recorded her own blood pressures, which reached systolic blood pressure of 225 mmHg.

Her new rheumatologist found hypocomplementemia and proteinuria, hydroxychloroquine was resumed, MMF changed to azathioprine, and lisinopril was prescribed. Over the next several weeks, her symptoms improved, but hypocomplementemia and proteinuria continued. Her nephrologist scheduled an elective kidney biopsy, but prior to her biopsy low-grade fevers, headache, pitting edema and hypertension recurred. She sought emergency care resulting in admission to our institution.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Hospital Assessment

On initial assessment, she was afebrile with a blood pressure of 170/90 mmHg, breathing comfortably with an oxygen saturation of 97% on room air. She was in no distress and had moderate periorbital edema. Her lungs were clear to auscultation. Examination of her lower extremities revealed synovitis in her left ankle and bilateral lower extremity pitting edema with an overlying palpable purpuric rash with a few shallow ulcers.

Her basic metabolic profile was within normal limits and included a BUN of 22 mg/dL and creatinine of 0.83 mg/dL. Her complete blood cell count was remarkable for a low, but stable hematocrit at 27% (lower limit of normal 36%). ESR and CRP were elevated at 27 mm/hr and 4.4 mg/L, respectively. Serologies yielded a positive ANA at 1:640 (speckled), while the remainder of the extractable nuclear and double-stranded DNA autoantibodies was negative. Complement levels were low, with C3 at 52 and C4 at 2 mg/dL, respectively (normal C3 90–180, C4 10–40 mg/dL). Her urine contained 3+ blood, 3+ protein and hyaline casts. The spot urine protein to creatinine ratio was 328:51, suggesting 6.4 g of urinary protein excretion over 24 hours. Antiphospholipid antibodies were negative, while ANCA and cryoglobulins were pending.

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, SLE (Lupus) Tagged With: Clinical, Diagnosis, kidney, outcome, patient care, SLE, stemic lupus erythematosusIssue: September 2015

You Might Also Like:
  • Case Report: Contagious Rash in Active Systemic Lupus Erythematosus
  • Proptosis in Systemic Lupus Erythematosus
  • Rheumatology Case Report: Bullous Lesions in Patient with Lupus
  • Systemic Lupus Erythematosus

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.