LUPUS PODOCYTOPATHY AN UNDERRECOGNISED ENTITY

Nephrotic syndrome is one of the common manifestations of systemic lupus erythematosus. Usually SLE patients with nephrotic range of proteinuria show diffuse proliferative lupus nephritis and membranous lupus nephritis, ISN RPS (International society of nephrology Renal pathological society) classes IV and V, respectively on histopathological examination . Here we are reporting a case of SLE presented with nephrotic syndrome. Renal biopsy showed mesangial proliferative lupus nephritis(class II) with MCD(Minimal change disease) like diffuse effacement of foot processes of podocytes in the absence of glomerular capillary wall immune deposits on electron microscopy. Patient had a complete remission with short course of high dose oral prednisolone therapy. The association of podocytopathy and SLE may not be a coincidence and this should be considered as one of the manifestations of lupus nephropathy. Keyword :Lupus podocytopathy, Minimal change disease, Prednisolone. INTRODUCTION: Incidence of clinically evident renal disease is 30 to 50% in patients with SLE at initial presentation. During follow up, 60% of the patients will develop lupus nephritis 1-4. Proteinuria is the most common presentation of lupus nephritis and it is usually below 1 g per day in mesangial proliferative lupus nephritis (ISN/RPS class II)5,6. Interestingly some SLE patients will present with nephrotic syndrome due to diffuse foot process effacement as in minimal change disease without any evidence of diffuse proliferative (class IV) or membranous (class V) lupus nephritis 7-17. Here we are reporting a case of podocytopathy associated with class II lupus nephritis. Lupus podocytopathy is not included in WHO as well as in the recent ISN/RPS classification18.