Tubulointerstitial lupus nephritis
Abstract
Background
Isolated or predominant tubulointerstitial lupus nephritis is rare.
Case Presentation
Here we report the case of a thirty eight years old male who was diagnosed with systemic lupus erythematosus (SLE) according to clinical and laboratory criteria and presented with impaired renal function and non nephrotic range proteinuria. Renal biopsy revealed normal glomeruli but interstitial momonuclear cell infiltration. Immunohiostochemistry (IHC) showed immune deposits in the tubular basement membranes (TBMs), and the peritubular capillary basement membranes (PTCBMs). He was started on high dose oral steroids, which were gradually tapered over one month. His renal functions improved over few days and normalized by the end of the first month of treatment. He was continued on low dose steroids and azathioprine with no evidence of relapse.
Conclusions
Predominant tubulointerstitial lupus can occur, although rarely; and it runs a favorable course with good response to treatment.
Two glomeruli, one of them with narrowed Bowman’s space, with focal interstitial infiltration and hyaline cast (H & E 4X).
The normal looking glomeruli. (H& E 40X).
Interstitial infiltrate with mononuclear and plasma cells (H & E 40X).
A Glomerulus with NO immune deposits (Immunoperoxidase IHC).
Tubulointerstitial C3 deposits (Immunoperoxidase IHC).
Tubulointerstitial IgA deposits (Immunoperoxidase IHC).
Notes
Implication for health policy/practice/research/medical education:
Renal tubulointerstitium can be involved in all classes of lupus nephritis but predominant tubulointerstitial lupus without evidence of glomerular lesion is rare. In this study we described a pure tubulointerstitial lupus nephritis.
Please cite this paper as: Ali A, Al-Windawi S. Tubulointerstitial Lupus nephritis. J Nephropathology. 2013; 2(1): 75-80. DOI: 10.5812/nephropathol.9000
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