Lupus nephritis with cryoglobulinemic glomerulonephritis features: a diagnostic conundrum

ABSTRACT

In this clinical case, we report an atypical and unique presentation of systemic lupus erythematosus (SLE) in a 39-year-old female with nephrotic syndrome. The patient exhibited class IV plus V lupus nephritis and extensive immune complex deposition within the intracapillary and arteriolar regions suggestive of cryoglobulinemic glomerulonephritis, despite no detectable circulating cryoglobulins. Electron microscopy revealed cryoglobulin-like deposit distribution in all glomerular examined compartments, namely subendothelial, intramembranous, subepithelial, and mesangial, apparently extending from the capillary hyaline thrombi. The case highlights the possibility of severe renal injury in SLE without circulating cryoglobulins and the diverse kidney manifestations associated with the disease. However, the impact on patient outcome was minimal, as classical treatment (id est National Institute of Health regimen) remained effective.

KEYWORDS:

• Circulating cryoglobulins
• cryoglobulinemic glomerulonephritis
• lupus nephritis
• systemic lupus erythematosus

Disclosure statement

No potential conflict of interest was reported by the author(s).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The dataset presented in this study can be found in the article.

Ethics statement

The studies involving human participants were reviewed and approved by the Ethics Committee of Dr Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania. The patient provided written informed consent to participate in this study. Written informed consent was obtained from individuals for the publication of any potential identifiable images or data included in this article.

Author contributions

GTB: original idea, manuscript preparation, data analysis, and interpretation.

SC: data acquisition, data interpretation, and manuscript correction.

SS: data acquisition, data interpretation, and manuscript correction.

MG: data acquisition, data interpretation, and manuscript correction.

GS: original idea, manuscript preparation, data analysis, and interpretation.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.