Case Report: Predominant Tubulointerstitial Lupus Nephritis or the Combination With IgG4-Related Disease?

Isolated or dominant tubulointerstitial lupus nephritis is rare. Here, we reported a 67-year-old man diagnosed with systemic lupus erythematosus (SLE) based on clinical and laboratory criteria, who was showing impaired renal function and non-nephrotic range proteinuria in the past 2 years. Renal biopsy showed almost normal glomeruli, but the tubulointerstitium showed “storiform” pattern with interstitial infiltration of IgG3 predominant plasma cells. Immunofluorescence showed linear and granular staining of IgG and C1q along TBM and interstitium. He started on medium dose of oral steroids and mycophenolate mofetil, which were gradually tapered. As a result, his renal function improved over a few days. Now, he continued on low dose steroids and mycophenolate mofetil with no evidence of relapse.

[1]  Amita Sharma,et al.  The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease , 2019, Annals of the rheumatic diseases.

[2]  M. Pollheimer,et al.  A patient with predominant interstitial nephritis as a renal manifestation of systemic lupus erythematosus. , 2019, Rheumatology.

[3]  Case Report Abstract , 2019, European Heart Journal Supplements.

[4]  Sreedhar Adapa,et al.  An Overlapping Case of IgG4-Related Disease and Systemic Lupus Erythematosus , 2019, Journal of investigative medicine high impact case reports.

[5]  L. Criswell,et al.  2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data‐Driven Methodology Involving Three International Patient Cohorts , 2017, Arthritis & rheumatology.

[6]  L. Criswell,et al.  2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome , 2016, Annals of the rheumatic diseases.

[7]  A. Levin,et al.  Recognizing IgG4-related tubulointerstitial nephritis , 2016, Canadian journal of kidney health and disease.

[8]  A. Dyer,et al.  Vimentin is a dominant target of in situ humoral immunity in human lupus tubulointerstitial nephritis , 2014, Arthritis Research & Therapy.

[9]  K. Okazaki,et al.  Comprehensive Diagnostic Criteria for IgG4-Related Disease , 2014 .

[10]  Ala Ali,et al.  Tubulointerstitial lupus nephritis. , 2013, Journal of nephropathology.

[11]  I. Narita,et al.  Light-microscopic characteristics of IgG4-related tubulointerstitial nephritis: distinction from non-IgG4-related tubulointerstitial nephritis. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[12]  T. Hibi,et al.  Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011 , 2012, Modern rheumatology.

[13]  吉田 一浩.  Light-microscopic characteristics of IgG4-related tubulointerstitial nephritis : distinction from non-IgG4-related tubulointerstitial nephritis , 2012 .

[14]  Su-xia Wang,et al.  Tubulointerstitial lesions of patients with lupus nephritis classified by the 2003 International Society of Nephrology and Renal Pathology Society system. , 2010, Kidney international.

[15]  J. Sánchez,et al.  Nefritis túbulo-intersticial aislada en paciente con lupus eritematoso sistémico , 2009 .

[16]  A. Komatsuda,et al.  Predominant tubulointerstitial nephritis in a patient with systemic lupus erythematosus: phenotype of infiltrating cells. , 2008, Clinical nephrology.

[17]  Y. Mori,et al.  Predominant tubulointerstitial nephritis in a patient with systemic lupus nephritis , 2005, Clinical and Experimental Nephrology.

[18]  L. Nakopoulou,et al.  Letter to the Editor , 2003 .

[19]  Ashutosh Kumar Singh,et al.  Predominant tubulointerstitial lupus nephritis. , 1996, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[20]  D. Gross,et al.  Chronic predominant interstitial nephritis in a patient with systemic lupus erythematosus: a follow up of three years and review of the literature. , 1987, Annals of the rheumatic diseases.

[21]  S. Makker.  Tubular basement membrane antibody-induced interstitial nephritis in systemic lupus erythematosus. , 1980, The American journal of medicine.

[22]  D. Droz,et al.  Immunologically-mediated acute renal failure of nonglomerular origin in the course of systemic lupus erythematosus [SLE]. Report of two cases. , 1979, The American journal of medicine.

[23]  J. Brentjens,et al.  Acute renal failure secondary to interstitial lupus nephritis. , 1978, Archives of internal medicine.

[24]  Robert T. McCluskey,et al.  Case 2-1976 , 1976 .

[25]  A D GUNN,et al.  Case of Anaphylaxis after Anaesthesia , 1943, British medical journal.