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An Overlapping Case of Lupus Nephritis and IgG4-Related Kidney Disease

机译：狼疮性肾炎与IgG4相关的肾脏疾病的重叠病例

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We report a case of a 71-year-old Filipino female who was admitted to the hospital for abdominal pain, vomiting and diarrhea of 8 days duration. The patient was found to have marked acute kidney injury (AKI), which required hemodialysis in the next 3 days. Extensive workup revealed hematuria, subnephrotic range proteinuria, elevated anti-nuclear antibody (ANA) and elevated total immunoglobulin G (IgG) levels, with normal IgG4 and anti-dsDNA levels. On kidney biopsy, mild membranous glomerulonephritis was found, along with autoimmune tubulointerstitial nephritis (TIN) with a “full-house” pattern of immune deposits. These findings were suggestive of lupus interstitial nephritis. However, IgG4+ plasma cells were detected in the interstitium by immunostaining, favoring a diagnosis of IgG4-related kidney disease (IgG4-RKD). Our case highlights the difficulty in differentiating lupus nephritis (LN) from IgG4-RKD in some patients, raising the suspicion that these two entities can co-exist.J Clin Med Res. 2015;7(7):575-581doi: http://dx.doi.org/10.14740/jocmr2189w
机译：我们报告了一例71岁的菲律宾女性，因腹部疼痛，呕吐和腹泻持续8天而入院。发现患者患有明显的急性肾损伤（AKI），需要在接下来的3天进行血液透析。广泛的检查显示血尿，肾功能不全蛋白尿，抗核抗体（ANA）升高和总免疫球蛋白G（IgG）升高，IgG4和抗dsDNA均正常。在肾脏活检中，发现轻度膜性肾小球肾炎，以及自身免疫性肾小管间质性肾炎（TIN），伴有“全屋”免疫沉淀。这些发现提示狼疮间质性肾炎。然而，通过免疫染色在间质中检测到IgG4 +浆细胞，有助于诊断与IgG4相关的肾脏疾病（IgG4-RKD）。我们的病例凸显了在某些患者中难以将狼疮性肾炎（LN）与IgG4-RKD区分的可能性，这使人们怀疑这两个实体可以共存。JClin Med Res。 2015; 7（7）：575-581doi：http：//dx.doi.org/10.14740/jocmr2189w

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