Kidney Week

Abstract: PUB564

A Case of Lupus Nephritis with Acute Tubulointerstitial Nephritis Presenting Multiple Low-Density Lesions on Contrast-Enhanced CT

Session Information

• Publication Only

Category: Trainee Case Report

• 1202 Glomerular Diseases: Immunology and Inflammation

Authors

• Yamano, Takahiro, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Takahiro Yamano,

• Kawahara, Hiroyuki, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Hiroyuki Kawahara,

• Hibino, Shinya, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Shinya Hibino,

• Nishioka, Ryo, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Ryo Nishioka,

• Zoshima, Takeshi, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Takeshi Zoshima,

• Hara, Satoshi, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Satoshi Hara,

• Ito, Kiyoaki, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Kiyoaki Ito,

• Mizushima, Ichiro, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Ichiro Mizushima,

• Fujii, Hiroshi, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Hiroshi Fujii,

• Kawano, Mitsuhiro, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Mitsuhiro Kawano,

Introduction

Lupus nephritis (LN) usually involves glomeruli but sometimes involves the tubulointerstitium and contributes to renal dysfunction. However, there have been no case reports of the radiological abnormalities of tubulointerstitial lesions in LN. Here, we report a case of LN with acute tubulointerstitial nephritis(TIN) presenting with multiple low-density lesions on contrast-enhanced computed tomography (CT).

Case Description

A 27-year-old Japanese woman was admitted to our hospital due to a suspected flare-up of systemic lupus erythematosus(SLE). She had been diagnosed 2 years previously with SLEbased on malar rash and positivity for anti-nuclear, anti-ds-DNA, and anti-Sm antibodies, and treatment with prednisolone (PSL) 5 mg/day was initiated. She was transferred to our hospital 4 months ago because of fever, fatigue, left small malar rash, and renal dysfunction. Bilateral renal multiple low-density lesions were detected on contrast-enhanced CT. Her symptoms recovered spontaneously, so she was discharged under continued treatment with PSL at 20 mg/day. Three weeks ago, after tapering the PSL to 16 mg/day, joint pain, palmar and nail erythema, and fever appeared gradually, and she was re-hospitalized. A blood test showed a creatinine level of 0.91 mg/dL with no reduction in complement and no elevation of the anti-ds-DNA antibody level. Urinalysis showed a urinary protein level of 0.10 g/gCr, no microscopic hematuria, and no granular or erythrocyte casts. Contrast-enhanced CT revealed remaining bilateral renal multiple low-density lesions. Renal biopsy showed diffuse lymphoplasmacytic infiltration in the tubulointerstitium, indicating acute TIN. In the glomeruli, mesangial cell proliferation and endocapillary hypercellularity were observed with IgG- and C3-predominant deposition, leading to a diagnosis of LN ISN/RPS class III (A). The fever and joint pain were alleviated, and bilateral renal multiple low-density lesions disappeared when the PSL dose was increased to 30 mg/day.

Discussion

LN with acute TIN can present with bilateral renal multiple low-density lesions on contrast-enhanced CT. Tubulointerstitial lesions of LN should be considered as a differential diagnosis of renal multiple low-density lesions.