Document Detail

Systemic lupus erythematosus presented as non-inflammatory necrotizing vasculopathy-induced ischemic glomerulopathy and small vessels-related ischemic cardiomyopathy.
MedLine Citation:
PMID:  12195789     Owner:  NLM     Status:  MEDLINE    
The clinical significance of lupus non-inflammatory necrotizing vasculopathy (NINV) is not well established. For example, since lupus renal NINV is usually reported to coexist with proliferative and active glomerulonephritis, it is difficult to demonstrate the role of NINV on renal pathophysiology. Here we report a 16-year-old SLE boy with renal NINV presenting as ischemic glomerulopathy and small vessels-related ischemic heart failure. The renal biopsy demonstrated mild proliferative glomerulonephritis and NINV initially, and one month later repeated renal biopsy showed NINV with ischemic glomerulopathy. These findings established that NINV, but not proliferative glomerulonephritis, was responsive for his acute renal failure (ARF). Another interesting question is about the pathophysiology of his myocardial dysfunction. This patient presented typical angina and congestive heart failure (CHF). Echocardiograms and ventriculography revealed dilatation of four chambers and low ejection fraction. Serial electrocardiograms demonstrated evolutionary ischemic changes. Coronary angiography revealed no abnormality of large vessels. These findings suggested small vascular lesions-induced myocardial ischemia was the underlying mechanism of dilated cardiomyopathy. As myocardial biopsy was not done in our case, we could only speculate, but not prove, that the NINV observed in renal biopsy may also involve in cardiac microvascular beds. Nevertheless, this interesting case emphasized the role of obliterative small vascular lesions in the pathophysiology of ARF and myocardial dysfunction. The patient was treated with high-dose corticosteroid, plasma infusion and hemodialysis. His cardiac function improved gradually, however the renal function did not recover.
J M Sung; S C Hsu; F F Chen; J J Huang
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Lupus     Volume:  11     ISSN:  0961-2033     ISO Abbreviation:  Lupus     Publication Date:  2002  
Date Detail:
Created Date:  2002-08-27     Completed Date:  2003-03-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9204265     Medline TA:  Lupus     Country:  England    
Other Details:
Languages:  eng     Pagination:  458-62     Citation Subset:  IM    
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China.
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MeSH Terms
Cardiomyopathies / diagnosis*
Diagnosis, Differential
Glomerulonephritis / diagnosis*
Ischemia / diagnosis*
Kidney Failure, Acute / diagnosis
Lupus Erythematosus, Systemic / diagnosis*
Polyarteritis Nodosa / diagnosis*

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