A Case of Lupus Nephritis Aggravated by Diabetic Nephropathy with a Rapid Decline in Kidney Function

Abstract

Lupus nephropathy is a glomerular lesion and one of the most severe organ localizations of systemic lupus erythematosus (SLE). Diabetic nephropathy, on the other hand, is a major cause for chronic kidney disease (CKD) as well as for end stage kidney disease (ESKD). We present the case of a 51-year-old woman with nephrotic syndrome diagnosed 4 months previously. Since the diagnosis was made, a rapid decline in renal function was observed – serum creatinine rose from 159 to 200 and to 462 μmol/l. Arterial hypertension was present for 2 years with BP values up to 200/90 mm Hg, as well as newly diagnosed diabetes mellitus which was insulin-treated due to the low renal function. The test for anti-dsDNA-63.3 was positive and ANA titers were 1: 320. The renal biopsy revealed a combination of lupus nephropathy and a nodular variant of diabetic nephropathy. Treatment with methylprednisolone, cyclophosphamide and heparin was initiated. This was followed by improvement in serum creatinine and proteinuria, by reduction of edema, decreased titers of anti-dsDNA and by improvement of the general well-being. A few months later, in the course of another intermittent infection, the patient’s condition deteriorated sharply, necessitating hemodialysis. Nephropathy secondary to lupus erythematosus is rarely seen in combination with diabetic nephropathy, but once they co-occur, a complicated course of the disease will eventually lead to serious kidney damage. The morphological examination of the renal biopsy aspirate is the only reliable mean to assess the nature of the glomerular changes and to make adequate therapeutic decisions.