Nephrotic syndrome secondary to lupus nephritis

Case contributed by Dr Jeremy Lim

Presentation

Three weeks of weight loss, intermittent fevers, worsening peripheral oedema, and ascites. Cachectic and anaemic.

Patient Data

Age: 35
Gender: Female

Severe generalised fluid overload (pleural effusions, pericardial effusion, large volume ascites, subcutaneous oedema). Right renal vein thrombosis. These findings can be seen in nephrotic syndrome - consider urinalysis.

Two hypodense with peripheral enhnacement liver lesions likely represent haemangiomata. No clear evidence of malignancy.

Case Discussion

Initial blood tests showed hypoalbuminemia (6 g/L) and anaemia (Hb 92 g/L). Urinalysis performed after the CT showed a protein concentration of 4.92 g/L (protein/creatinine ratio 593). Together with the severe fluid overload seen on CT, these findings are diagnostic of nephrotic syndrome. Nephrotic syndrome is known to cause a hypercoagulable state, and it is a common cause of renal vein thrombosis. The patient was subsequently diagnosed with SLE and lupus nephritis (positive ANA and anti-dsDNA, weak positive ENA and Anti-Sm).

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Case information

rID: 52544
Case created: 11th Apr 2017
Last edited: 30th May 2017
System: Urogenital
Inclusion in quiz mode: Included

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