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Uysal C, Ketenci Ertas S, Civan M, Akgun H, Kocyigit I. Pauci-immune crescentic glomerulonephritis caused to dilemma in a patient with suspected systemic lupus erythematosus: a case report. CEN Case Rep 2024; 13:174-180. [PMID: 37837535 PMCID: PMC11144177 DOI: 10.1007/s13730-023-00825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/13/2023] [Indexed: 10/16/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease and there is a distinct differentiation of clinical manifestations. Lupus nephritis (LN) is clinically apparent in approximately half of patients. A kidney biopsy is essential to define the kidney injury, exclude other injurious causes, and determine the histopathologic subtypes. Autoantibodies are crucial to the pathogenesis and the deposition of immune complexes in glomeruli is a hallmark of LN. The histopathology of LN is quite varied. Despite pauci-immune LN being an unexpected condition in SLE, it has been observed rarely with the presence of antineutrophil cytoplasmic autoantibodies (ANCA). We present a young male who was admitted to the emergency with syncope. The brain imaging revealed small infarct areas and signs of cerebral vasculitis. Also, he had elevated inflammatory markers, moderate proteinuria, and preserved kidney function. Anti-nuclear antibodies and anti-dsDNA were positive. Pauci-immune crescentic glomerulonephritis (PICGN) was observed in a kidney biopsy, however, ANCA was negative. SLE diagnosis was established by neurological manifestation, specific antibodies, proteinuria, and kidney biopsy findings. We administered a combination induction regimen, including pulse steroid and parenteral cyclophosphamide. The proteinuria was resolved in the follow-up. Our case highlights that SLE-associated ANCA-negative PICGN can be the initial presentation in the absence of typical manifestations. LN exhibits various pathological mechanisms in the kidney. As a consequence, SLE should be considered in the differential diagnosis of all forms of kidney injury.
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Affiliation(s)
- Cihan Uysal
- Department of Nephrology, Erciyes University School of Medicine, Dede Efendi Street, Köşk District, Melikgazi, 38030, Kayseri, Turkey.
| | | | - Merve Civan
- Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hulya Akgun
- Department of Pathology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ismail Kocyigit
- Department of Nephrology, Erciyes University School of Medicine, Dede Efendi Street, Köşk District, Melikgazi, 38030, Kayseri, Turkey
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Fentie K, Singanamala S, Hozayen O, Altaf L. Granulomatosis With Polyangiitis Presenting as Chest Pain: A Case Report. Cureus 2023; 15:e38204. [PMID: 37252550 PMCID: PMC10224739 DOI: 10.7759/cureus.38204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a relatively rare systemic autoimmune disorder of small and medium size blood vessels affecting multiple organs with a wide range of clinical presentations. We present a 57-year-old Caucasian male who presented to the ER with midsternal chest pain. He was hospitalized for non-ST elevated myocardial infarction (NSTEMI) and later diagnosed with pauci-immune necrotizing crescentic glomerulonephritis confirmed with renal biopsy.
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Affiliation(s)
- Kindalem Fentie
- Medicine, Trinity Medical Sciences University, Warner Robins, USA
| | | | - Omar Hozayen
- Medicine, Trinity Medical Sciences University, Warner Robins, USA
| | - Lareb Altaf
- Medicine, Trinity Medical Sciences University, Warner Robins, USA
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Zhang X, Yang P, Khan A, Xu D, Chen S, Zhai J, Zhang B, Xiong T, Wang Y, Li Z. Serum tsRNA as a novel molecular diagnostic biomarker for lupus nephritis. Clin Transl Med 2022; 12:e830. [PMID: 35593207 PMCID: PMC9121311 DOI: 10.1002/ctm2.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/31/2022] [Accepted: 04/05/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Xiaoshan Zhang
- College of Life Science, Yangtze University, Jingzhou, China.,Department of Clinical Laboratory, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ping Yang
- Department of Clinical Laboratory, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Adeel Khan
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, National Demonstration Center for Experimental Biomedical Engineering Education, Southeast University, Nanjing, China
| | - Dongjie Xu
- College of Life Science, Yangtze University, Jingzhou, China.,Department of Clinical Laboratory, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Shanshan Chen
- Department of Rheumatic Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Junbin Zhai
- Department of Clinical Laboratory, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Bin Zhang
- College of Life Science, Yangtze University, Jingzhou, China.,Department of Clinical Laboratory, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Tao Xiong
- College of Life Science, Yangtze University, Jingzhou, China
| | - Yanbo Wang
- State Key Laboratory of Pharmaceutical Biotechnology and Department of Physiology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, NJU Advanced Institute of Life Sciences (NAILS), Nanjing University, Nanjing, China
| | - Zhiyang Li
- Department of Clinical Laboratory, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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