U06-4031# 535572610

20 years old female. SLE 2 yrs.Persistently active urinary sediment.Creat 61.

20 yo Native female with SLE -2004: malar rash, fatigue, wt loss, alopecia, arthralgias x 8 months-Rheum: ANA+, dsDNA –ve, anti-Smith +ve, low C3/C4, sCr 52, bland u/a

Tx: Plaquenil, Prednisone 10-Sx resolved, April, 2005: tapered Pred to 5 mg -Sept, 2005: Hospitalized: fever, Htn, u/a: >50 RBC, proteinuria ~2g/d, sCr 69 -Tx with ?Abx “pyelo” sx resolved-Dec, 2005 (Nephro):

Arthralgias, mild anorexia. N BP, slight malar rash sCr 62, sAlbumin 25, Hb 112 NCNC, C3/C4 N u/a: no spot proteinuria, 6-10 RBC-March 1, 2005:

Difficulty follow-upOngoing hematuria (>50 RBC/HPF), recurrent proteinuria (~1g/d)

biopsy 

• IgG-strong coarsely granular capillary loop staining• IgA- mild to moderate coarsely granular capillary loop

staining• IgM- negative• C3- moderate coarsely granular capillary loop staining• C1q-negative• Kappa- moderate coarsely granular capillary loop staining• Lambda- NA• Fibrin- negative• Albumin- moderate hyaline droplet changes in tubular

cytoplasm

IF

IgG

IgA

C3

Kappa

Albumin

Diagnosis:Renal Biopsy:Mixed Membranous and Focal Proliferative lupus nephritis, of low activity and no chronicity