Abstract
We report the case of an 11-year-old girl who developed lupus nephritis after remission of membranoproliferative glomerulonephritis (MPGN). She developed nephrotic syndrome with renal dysfunction and hypocomplementemia at 7 years old. Renal biopsy showed mesangial and endocapillary proliferation with severe lobulation and double-contoured basement membranes, indicating MPGN. Two years steroid pulse therapy and an alternate-day regimen of PSL promoted temporarily improvement of symptoms. This was also demonstrated by microscopic finding mild improvement of proliferative change. However, Proteinuria, hematuria and hypocomplementemia reappeared with appearance of butterfly rash at 11 years old. It was also noted positive antinuclear antibody, a high titer of anti-dsDNA antibody, and lupus nephritis (ISN/RPS classification class IV-G(A/C)) by renal biopsy. These findings diagnosed systemic lupus erythematosus (SLE). Steroid pulse therapy and intravenous low-dose cyclophosphamide therapy initiated to induce remission. Serial renal immunofluorescence microscopic finding revealed the shift to full-house nephropathy. Thus, this case warrants initial presentation of MPGN pattern may develop SLE later. The possibility of SLE must be considered in cases presenting with the MPGN pattern with variegated depositions of complement and immunoglobulin.
