Revista de nefrología y terapéutica

End-stage Renal Disease Due to Membranous Lupus Nephritis: Is Antiphospholipid Syndrome Misdiagnosed or Underestimated?

Abstract

Mabel Aoun *,Georges Khalil ,Georges Aftimos

We report a case of a 45-year-old woman who presented for nephrotic syndrome and anemia. Her kidney biopsy confirmed the diagnosis of class V membranous lupus nephritis. She had also criterias for antiphospholipid syndrome: miscarriages and antiphospholipid antibodies. She received as immunosuppression treatment corticosteroids and mycophenolate mofetil. Her kidney function deteriorated and three bolus of cyclophosphamide were given. She developed a severe pneumonia and became uremic. She underwent two sessions of acute hemodialysis and developed deep venous thrombosis in her leg. Anticoagulation was then started and her kidney function stabilized for a few months until she was put on chronic dialysis three years and a half after her initial presentation. We emphasize on the factors that worsen the renal prognosis in membranous lupus nephritis patients. We also highlight the importance of recognizing early the antiphospholipid syndrome in lupus nephritis in order to treat it and prevent eventually end-stage renal failure.