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Glomerular podocytopathy in patients with systemic lupus erythematosus.

Abstract

A series of patients with systemic lupus erythematosus (SLE) and proteinuria were studied to determine whether nephrotic-range proteinuria was associated with diffuse epithelial cell foot process effacement in the absence of peripheral glomerular immune aggregate deposition. Biopsies from patients with known or suspected SLE and a histologic diagnosis of (1) normal by light microscopy, (2) mesangial proliferative glomerulonephritis, or (3) focal segmental glomerulosclerosis were studied. Biopsies were excluded when they demonstrated endocapillary proliferation or necrosis by light microscopy or electron-dense glomerular basement membrane deposits by electron microscopy. Patients were required to fulfill four of 11 American Rheumatologic Association criteria for the diagnosis of SLE, and proteinuria could not be associated with nonsteroidal anti-inflammatory drug use. Eighteen biopsies were studied, eight from patients with nephrotic-range proteinuria (>/=3 g/d) and 10 from patients with non-nephrotic proteinuria. The time from diagnosis of SLE to biopsy was shorter for nephrotic patients that for nonnephrotic patients. Seven of eight biopsies from nephrotic patients demonstrated at least 80% foot process effacement, whereas no biopsy from a nonnephrotic patient exhibited >20% effacement. There were no other significant pathologic differences between the nephrotic and nonnephrotic patients. The single common morphologic feature associated with nephrotic proteinuria was diffuse visceral epithelial cell foot process effacement. It is concluded that the development of nephrotic-range proteinuria in patients with SLE without peripheral immune aggregate deposition or endocapillary proliferation on renal biopsy is more likely a manifestation of SLE than the coexistence of idiopathic minimal-change glomerulopathy and SLE.

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  • Authors+Show Affiliations

    ,

    Section of Nephrology, Department of Medicine, Rush University Medical Center, 1426 W. Washington Boulevard, Chicago, IL 60607, USA.

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    Source

    MeSH

    Adult
    Antigen-Antibody Complex
    Biopsy
    Capillaries
    Female
    Follow-Up Studies
    Humans
    Kidney Glomerulus
    Lupus Nephritis
    Male
    Middle Aged
    Nephrosis, Lipoid
    Proteinuria
    Retrospective Studies

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15548564

    Citation

    Kraft, Steven W., et al. "Glomerular Podocytopathy in Patients With Systemic Lupus Erythematosus." Journal of the American Society of Nephrology : JASN, vol. 16, no. 1, 2005, pp. 175-9.
    Kraft SW, Schwartz MM, Korbet SM, et al. Glomerular podocytopathy in patients with systemic lupus erythematosus. J Am Soc Nephrol. 2005;16(1):175-9.
    Kraft, S. W., Schwartz, M. M., Korbet, S. M., & Lewis, E. J. (2005). Glomerular podocytopathy in patients with systemic lupus erythematosus. Journal of the American Society of Nephrology : JASN, 16(1), pp. 175-9.
    Kraft SW, et al. Glomerular Podocytopathy in Patients With Systemic Lupus Erythematosus. J Am Soc Nephrol. 2005;16(1):175-9. PubMed PMID: 15548564.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Glomerular podocytopathy in patients with systemic lupus erythematosus. AU - Kraft,Steven W, AU - Schwartz,Melvin M, AU - Korbet,Stephen M, AU - Lewis,Edmund J, Y1 - 2004/11/17/ PY - 2004/11/19/pubmed PY - 2005/6/23/medline PY - 2004/11/19/entrez SP - 175 EP - 9 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 16 IS - 1 N2 - A series of patients with systemic lupus erythematosus (SLE) and proteinuria were studied to determine whether nephrotic-range proteinuria was associated with diffuse epithelial cell foot process effacement in the absence of peripheral glomerular immune aggregate deposition. Biopsies from patients with known or suspected SLE and a histologic diagnosis of (1) normal by light microscopy, (2) mesangial proliferative glomerulonephritis, or (3) focal segmental glomerulosclerosis were studied. Biopsies were excluded when they demonstrated endocapillary proliferation or necrosis by light microscopy or electron-dense glomerular basement membrane deposits by electron microscopy. Patients were required to fulfill four of 11 American Rheumatologic Association criteria for the diagnosis of SLE, and proteinuria could not be associated with nonsteroidal anti-inflammatory drug use. Eighteen biopsies were studied, eight from patients with nephrotic-range proteinuria (>/=3 g/d) and 10 from patients with non-nephrotic proteinuria. The time from diagnosis of SLE to biopsy was shorter for nephrotic patients that for nonnephrotic patients. Seven of eight biopsies from nephrotic patients demonstrated at least 80% foot process effacement, whereas no biopsy from a nonnephrotic patient exhibited >20% effacement. There were no other significant pathologic differences between the nephrotic and nonnephrotic patients. The single common morphologic feature associated with nephrotic proteinuria was diffuse visceral epithelial cell foot process effacement. It is concluded that the development of nephrotic-range proteinuria in patients with SLE without peripheral immune aggregate deposition or endocapillary proliferation on renal biopsy is more likely a manifestation of SLE than the coexistence of idiopathic minimal-change glomerulopathy and SLE. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/15548564/Glomerular_podocytopathy_in_patients_with_systemic_lupus_erythematosus_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=15548564 DB - PRIME DP - Unbound Medicine ER -