Document Type : case report
Authors
- Neda Ghorbani-khosroshahi 1
- Vadood Javadi 2
- Fatemeh Nili 3
- Hananeh Gholamali-Majdabadi 4
- Masoumeh Mohkam 1
- Ghazal Azad 4
1 Pediatric Nephrology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Pediatric Rheumatologist, Pediatric Pathology Research Center, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
4 School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
Background: Lupus nephritis (LN) is a serious renal complication of systemic lupus erythematosus (SLE), particularly in the pediatric population. It often presents with persistent hematuria and proteinuria, which can overlap with other glomerular disorders. This case report highlights the diagnostic challenges associated with LN in the presence of nonspecific clinical features.
Case presentation: A 4-year-old boy was admitted for evaluation of persistent recurrent gross hematuria, which continued despite previous surgery for suspected urethral stricture. Initial laboratory tests showed significant hematuria, proteinuria, and mildly elevated inflammatory markers, raising concerns for nephritis. The patient was initially diagnosed with post-streptococcal glomerulonephritis (PSGN), but this was later excluded. A renal biopsy revealed membranous glomerulonephritis (MGN) stage I-II, and further immunological testing, including antinuclear antibodies (ANA) and anti-dsDNA antibodies, led to the final diagnosis of lupus nephritis class V. The findings were consistent with systemic lupus erythematosus, confirming the diagnosis.
Conclusion: We report a pediatric patient diagnosed with Class V lupus nephritis based on renal biopsy, presenting with recurrent hematuria. This case emphasizes the importance of early nephrology consultation, serial testing, and renal biopsy for accurate diagnosis and appropriate management.
Keywords
- Bignall OR, Dixon BP. Management of hematuria in children. Current treatment options in pediatrics. 2018 Sep;4(3):333-49.
- Viteri B, Reid-Adam J. Hematuria and proteinuria in children. Pediatrics in review. 2018 Dec 1;39(12):573-87.
- Ponticelli C. Membranous nephropathy. Journal of nephrology. 2007 May 1;20(3):268-87.
- Valentini RP, Mattoo TK, Kapur G, Imam A. Membranous glomerulonephritis: treatment response and outcome in children. Pediatric Nephrology. 2009 Feb;24(2):301-8.
- Kleinknecht C, Levy M, Gagnadoux MF, Habib R. Membranous glomerulonephritis with extra-renal disorders in children. Medicine (Baltimore). 1979;58(3):219-28.
- Levy DM, Kamphuis S. Systemic lupus erythematosus in children and adolescents. Pediatric Clinics of North America. 2012 Apr;59(2):345.
- Anders HJ, Fogo AB. Immunopathology of lupus nephritis. InSeminars in immunopathology 2014 Jul (Vol. 36, No. 4, pp. 443-459). Berlin/Heidelberg: Springer Berlin Heidelberg.
- Bennett M, Brunner HI. Biomarkers and updates on pediatrics lupus nephritis. Rheumatic diseases clinics of North America. 2013 Jul 16;39(4):833.
- Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis & Rheumatism. 2012 Aug;64(8):2677-86.
- Hahn BH, Mcmahon MA, Wilkinson A, Wallace WD, Daikh DI, Fitzgerald JD, et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis care & research. 2012 Jun;64(6):797-808.
- Sinha R, Raut S. Pediatric lupus nephritis: Management update. World journal of nephrology. 2014 May 6;3(2):16.
- Kambham N. Postinfectious glomerulonephritis. Advances in anatomic pathology. 2012 Sep 1;19(5):338-47.
- Menon S, Valentini RP. Membranous nephropathy in children: clinical presentation and therapeutic approach. Pediatric Nephrology. 2010 Aug;25(8):1419-28.
- Ostrov BE. Reliability and reproducibility of antinuclear antibody testing in pediatric rheumatology practice. Frontiers in medicine. 2023 Jan 9;9:1071115.
- Alsharif AA, Almutairi AM, Basahl EB, Alshathri AA, Kari JA, Shalaby MA, et al. Juvenile lupus-like with negative serology: a clinical dilemma and diagnostic challenge. Journal of Rheumatic Diseases. 2025 Jan 1;32(1):57-62.
- Vazzana KM, Daga A, Goilav B, Ogbu EA, Okamura DM, Park C, et al. Principles of pediatric lupus nephritis in a prospective contemporary multi-center cohort. Lupus. 2021 Sep;30(10):1660-70.
- Pennesi M, Benvenuto S. Lupus nephritis in children: novel perspectives. Medicina. 2023 Oct 16;59(10):1841.
- Almaani S, Parikh SV. Membranous lupus nephritis: a clinical review. Advances in Chronic Kidney Disease. 2019 Sep 1;26(5):393-403.
- Pinheiro SV, Dias RF, Fabiano RC, Araujo SD, Silva AC. Pediatric lupus nephritis. Brazilian Journal of Nephrology. 2018 Nov 14;41(2):252-65.
- Tunnicliffe DJ, Singh‐Grewal D, Kim S, Craig JC, Tong A. Diagnosis, monitoring, and treatment of systemic lupus erythematosus: a systematic review of clinical practice guidelines. Arthritis care & research. 2015 Oct;67(10):1440-52.
)