Non-lupus glomerulonephritis in a patient with systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is a chronic autoimmune disease that can affect almost any organ system. Lupus nephritis [LN] is one of the most serious manifestations of SLE. The occurrence of nonlupus glomerulopathies has been rarely reported in patients with SLE. Here, we report a case of male Kuwaiti patient suffering from SLE with microscopic hematuria and nonnephrotic-range proteinuia. The renal biopsy findings showed IgA nephropathy. Although the incidence of IgA nephropathy is high in Kuwait, we believe that this is the first report of a Kuwaiti patient in whom SLE presented with IgA nephropathy rather than LN

Clinical and histopathological spectrum of IgA nephropathy in Kuwait

Little is known about the nature and the course of IgA nephropathy [IgAN] in Arab countries. The aim of this work was to study the spectrum of clinical presentation and histopathological findings at our institution. Retrospective review, all renal biopsies at the Mubarak Al Kabeer Hospital between January 2000 and December 2004. Cases of IgA nephropathy were selected, and their medical records and biopsy findings were reviewed. Eighty patients [9.2% of all native kidney biopsies] were diagnosed to have IgAN nephropathy. Sixty-nine biopsies were included in the study; 11 were excluded. Forty-three [62.3%] patients were male and 26 [37.7] patients were female. Fifty [72.5%] patients were below the age of 40 years. Mean [SD] duration of follow-up was 3.6 [1.3] years. The first presentation included nephritic-range proteinuria [49.3%] and renal impairment [50.7%]. During the follow-up period, 56 [81.2%] patients were stable or improved. Hass classification of biopsies showed 36.2% had class I, 27.5% had class II, 13.0% had class III, 5.8% had class IV, and 17.4% had class V IgAN. Females had milder forms of the disease than males. Macroscopic hematuria and renal impairment at presentation were seen more in patients with class IV and V IgAN. The presenting serum creatinine and uric acid values were higher in those with Hass classes III to V. Deterioration of renal function during the follow-up period was more significant in the presence of hypertension, renal impairment, or macroscopic hematuria at the time of biopsy. The prevalence of IgAN in Kuwait is about 9.2%. Renal impairment or macroscopic hematuria at presentation was seen in patients with more aggressive renal lesions and contributed to poor outcome