Diagnostic Challenge of Cardiorenal Involvement in Active Systemic Lupus Erythematosus:
Lupus Nephritis with Rapidly Progressive Renal Dysfunction: A Case Report
Abstract
Renal and cardiac involvement in active systemic lupus erythematosus (SLE) may pose a diagnostic challenge because clinical, serological, and histopathological findings do not always correlate. A 20-year-old woman with a history of SLE presented with edema, foamy urine, decreased urine output, arthralgia, oral ulcers, and orthopnea. Laboratory and imaging findings revealed severe proteinuria, hematuria, urinary casts, hypocomplementemia, elevated serum creatinine, heart failure with reduced ejection fraction with an ejection fraction of 37%, pericardial effusion, and cardiomegaly. Kidney biopsy demonstrated class III+V lupus nephritis, with an activity index of 8/24, chronicity index of 8/12, fibrous and fibrocellular crescents each found in 1 of 5 viable glomeruli, and 60% interstitial fibrosis/tubular atrophy. Immunofluorescence showed granular deposition of IgG, IgA, IgM, C3, and C1q. Although the clinical course resembled rapidly progressive glomerulonephritis, the non-dominant crescentic lesions made “rapid decline in kidney function” a more appropriate term than classic RPGN. Cardiac dysfunction may represent suspected myocardial involvement, volume overload, anemia, uremia, or a combination of these factors. Kidney biopsy and integrated cardiac evaluation are essential for assessing disease activity, chronicity, and prognosis in cardiorenal involvement of active SLE.
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