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Zaarour M, Weerasinghe C, Eter A, et al. An Overlapping Case of Lupus Nephritis and IgG4-Related Kidney Disease. J Clin Med Res. 2015;7(7):575-81doi: 10.14740/jocmr2189w.
Zaarour, M., Weerasinghe, C., Eter, A., El-Sayegh, S., & El-Charabaty, E. (2015). An Overlapping Case of Lupus Nephritis and IgG4-Related Kidney Disease. Journal of clinical medicine research, 7(7), 575-81. https://doi.org/10.14740/jocmr2189w
Zaarour, Mazen, et al. "An Overlapping Case of Lupus Nephritis and IgG4-Related Kidney Disease." Journal of clinical medicine research vol. 7,7 (2015): 575-81. doi: https://doi.org/10.14740/jocmr2189w
Zaarour M, Weerasinghe C, Eter A, El-Sayegh S, El-Charabaty E. An Overlapping Case of Lupus Nephritis and IgG4-Related Kidney Disease. J Clin Med Res. 2015 Jul;7(7):575-81. doi: 10.14740/jocmr2189w. Epub 2015 May 08. PMID: 26015827; PMCID: PMC4432904.
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J Clin Med Res. 2015 Jul;7(7):575-81. doi: 10.14740/jocmr2189w. Epub 2015 May 08.

An Overlapping Case of Lupus Nephritis and IgG4-Related Kidney Disease.

Journal of clinical medicine research

Mazen Zaarour, Chanudi Weerasinghe, Ahmad Eter, Suzanne El-Sayegh, Elie El-Charabaty

Affiliations

  1. Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.
  2. Department of Medicine, Division of Nephrology, Staten Island University Hospital, Staten Island, NY, USA.

PMID: 26015827 PMCID: PMC4432904 DOI: 10.14740/jocmr2189w

Abstract

We report a case of a 71-year-old Filipino female who was admitted to the hospital for abdominal pain, vomiting and diarrhea of 8 days duration. The patient was found to have marked acute kidney injury (AKI), which required hemodialysis in the next 3 days. Extensive workup revealed hematuria, subnephrotic range proteinuria, elevated anti-nuclear antibody (ANA) and elevated total immunoglobulin G (IgG) levels, with normal IgG4 and anti-dsDNA levels. On kidney biopsy, mild membranous glomerulonephritis was found, along with autoimmune tubulointerstitial nephritis (TIN) with a "full-house" pattern of immune deposits. These findings were suggestive of lupus interstitial nephritis. However, IgG4+ plasma cells were detected in the interstitium by immunostaining, favoring a diagnosis of IgG4-related kidney disease (IgG4-RKD). Our case highlights the difficulty in differentiating lupus nephritis (LN) from IgG4-RKD in some patients, raising the suspicion that these two entities can co-exist.

Keywords: IgG4-related kidney disease; IgG4-related tubulointerstitial nephritis; Lupus nephritis; Membranous nephropathy; Tubulointerstitial nephritis

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