An Unusual Case of Crescentic Lupus Nephritis Presenting With Normal Renal Function

Figures & data

Figure 1.  Renal biopsy images.

(A&B) Light microscopy of sections of renal cortex and medulla with active cellular and fibrocellular crescents. Frequent spike formation and segmental subendothelial deposits are seen. (C) Direct immunofluorescence of the renal cortex shows glomeruli with granular staining in the mesangial and capillary walls for IgG, IgA, IgM, C3, C1q, kappa and lambda light chains. (D) Electron microscopy of a glomerulus exhibiting immune-type electron-dense deposits in the subepithelial, intramembranous and mesangial locations. Glomerular basement membranes are irregularly thickened and distorted by the deposits.

Table 1.  Trend of laboratory data.

Variable	Reference range	Prior to admission	Day of admission	1 month follow-up	7 month follow-up
Serum creatinine (mg/dl)	0.5–1.2	0.93	1.00	0.8	0.75
Protein/creatinine ratio (g/g of creatinine)	0–0.2	4.0	4.0	9.1	3.6
Anti-dsDNA antibody (IU/ml)	<4	–	29	2	<1
Complement C3 (mg/dl)	90–180	–	48	59	105
Complement C4 (mg/dl)	16–47	–	23	28	36
Erythrocyte sedimentation rate (mm/h)	0–15	53	49	13	3
Albumin (g/dl)	3.2–5.5	1.7	1.5	1.5	3.0

Table 2.  The 2003 International Society of Nephrology/Renal Pathology Society classification of lupus nephritis.

Class I	Minimal mesangial lupus nephritis
Class II	Mesangial proliferative lupus nephritis
Class III	Focal lupus nephritis
Class IV	Diffuse segmental (IV-S) or global (IV-G) lupus nephritis
Class V	Membranous lupus nephritis
Class VI	Advanced sclerosing lupus nephritis

Reproduced with permission from [11] © Nature Publishing Group (2004).

Weening JJ , D'AgatiVD, SchwartzMMet al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J. Am. Soc. Nephrol.15(2), 241–250 (2004).

 PubMed Web of Science ®Google Scholar