MINIMAL CHANGE DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSIS - A RARE CASE REPORT

Background- Nephrotic syndrome in SLE most commonly occurs with class V and class IV Lupus Nephritis.Non-lupus renal disease in SLE is a rare coexistence. Non-lupus minimal Change disease occurs in less than 2percent in SLE. We report a patient with Systemic lupus erythymatosus presented to us with Nephrotic syndrome with a biopsy of minimal change disease without immune deposits. Casereport- 22 year old female presented with fever, symmetrical arthritis involving small and medium joints, chronic diarrhea of 3 months duration. She had oral ulcers, malar rash, and Coombs positive Haemolytic anemia,raised ESR,positive ANA, nephrotic proteinuria, microhaematuria, normal GFR, normal lipid profile and hypoalbuminemia.She was only on irregular oral prednisolone for 3 months before.Renal Biopsy on contrary showed Normal Light microscopic features,negative Immunofluorescence study with electron microscopy showing moderate foot process effacement with no electron dense deposits anywhere in the Mesangial,capillary walls and tubular segments.The above features are consistent with Non-lupus Minimal Change Disease. She was started on oral Prednisolone 1mg per kg per day. She underwent complete remission in 4 weeks and continued to be in remission even now.The simultaneous occurrence of Minimal Change Disease in a Lupus patient is very rare and only few case reports are available world wide. Such lesion responds dramatically to oral corticosteroids as in case of typical Adult onset idiopathic Minimal Change Disease