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28 February 2023 : Case report  China (mainland)

[In Press] A Case of Lupus Nephritis Preceded by Minimal Change Disease and Membranous Glomerulonephritis

Unusual clinical course, Mistake in diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents

Fengxia Zhang1A, Nan Jiang2BCDEF, Karthick Kumaran Munisamy Selvam1BCDEF, Bohou Li2BC, Qiong Wu2BC, Sichun Wen3BC, Ruiquan Xu4DEF, Shuangxin Liu2AFG

DOI: 10.12659/AJCR.938402

Am J Case Rep In Press; DOI: 10.12659/AJCR.938402  

Available online: 2023-02-28, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Lupus nephritis (LN) is the most common and serious complication of systemic lupus erythematosus (SLE). Minimal change disease (MCD) and primary membranous nephropathy (PMN) are the 2 most common causes of primary nephrotic syndrome. Our purpose in publishing this case report is to introduce an unusual clinical course and initial renal biopsy revealed MCD and then PMN in second renal biopsy. Subsequently, a third renal biopsy resulted in a final diagnosis of LN. To the best of our knowledge, this is the first such report.
The 31-year-old male patient was initially diagnosed with MCD after the first renal biopsy in 2004. He improved with initial management and had a complete remission for 9 years. After 9 years, the patient again presented with heavy proteinuria without systemic lupus erythematous finding and he was diagnosed with MN following the second renal biopsy. Seven years later, he again developed proteinuria alone with concurrent systemic symptoms of systemic lupus erythematosus, and a third biopsy was performed, leading to final diagnosis as LN. He was well managed with the methylprednisolone and cyclophosphamide (CTX) regimen, which improved renal function and spared the patient from continuous hemodialysis.
In rare case, MCD may represent an early phase of lupus nephritis, which may subsequently develop into severe lupus nephritis.

Keywords: Lupus Nephritis; Glomerulonephritis, Membranous; Lupus Erythematosus, Systemic; Nephrosis, Lipoid


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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923