Focal segmental glomerulosclerosis in systemic lupus erythematosus: one or two glomerular diseases / Glomerulosclerose segmentar e focal em lúpus eritematoso sistêmico: uma ou duas doenças

ABSTRACT

Some patients with clinical and/or laboratory diagnosis of systemic lupus erythematosus (SLE) present with nephritis which from the morphological point of view does not fit in one of the 6 classes described in the WHO classification of lupus nephritis. On the other hand, nonlupus nephritis in patients with confirmed SLE is rarely reported. This condition may not be so uncommon as it seems. The associated glomerular lesions most frequently described are amyloidosis and focal segmental glomerulosclerosis (FSGS). We report on a 46 year-old, caucasian woman, who fulfilled the American College of Rheumatology criteria for SLE diagnosis arthritis, positive anti-DNA, ANA, anti-Sm antibodies, and cutaneous maculae. During the follow-up, she presented arthralgias, alopecia, vasculitis, lower extremities edema and decreased serum levels of C3 and C4. Proteinuria was initially nephrotic, but reached negative levels. The serum creatinine varied from 0.7 to 3.0 mg/dl. The patient was submitted to the first renal biopsy at admission and to the second one, 3 years later, with diagnosis of minimal change disease and FSGS, respectively. No deposits were demonstrated by immunofluorescence. In the present case, we believe that the patient had SLE and developed an idiopathic disease of the minimal change disease-FSGS spectrum.