Military Medical Academy, Bulgaria
Title: Combination of lupus nephritis and diabetic nephropathy with rapid depression of renal function
Biography: Violina Minkova
A 51 year-old woman with nephrotic syndrome since 6 months-proteinuria 8.1g/ 24 h, serum albumin 29, 25, 19.6 g/l, oedema, rapid depression of renal function-serum creatinin 159- 200-462 mmol/l; Hypertension since 2 years; Diabetes mellitus since May 2018; Anti-ds DNA-63.3; Sonography: the two kidneys are of normal size and location; echodencity- І degree; Renal biopsy: 21 glomeruli, 3-obsolescent; In some of the glomeruli a moderate mesangial hypercellularity is seen. In the mesangial regions of most glomeruli hyaline nodules with cellular borders, fibrin caps and hyaline thrombi are seen. In few glomeruli there is an extracapillar proliferation with forming of crescents. Many areas of atrophic tubules and mononuclear infiltrates in the interstitium are seen as well; Blood vessels-severe hyalinosis in the walls of the small arteria and arterioles; Immunofluorescence: light segmental subendothelial IgA deposition and 2-3+ IgM, 3+ C1q and 4+C3 with the same localization. The morphological diagnosis was combination of lupus nephritis and diabetic nephropathy, causing a rapid depression of renal function. A therapy with i.v. application of Metjylprednizolon 250 mg, Endoxan 500 mg, Klexan 2x 0.4 ml and symptomatical medicine was prescribed. Serum creatinin decreased to 395 mmol/l; oedema reduced and the cough disappeared.