Background and aims Patients with lysinuric protein intolerance (LPI) due to inherited defect of cationic amino acid transport in intestine and renal tubules may have aberrant immune responses leading to multiple organ involvement. The renal involvement with immune complex glomerulonephritis in LPI is albeit rare and has not been well established.
Methods We report a 4-year-old boy manifested nephrotic syndrome with renal histological findings showing immune complex glomerulonephritis highly suggested of lupus nephritis, but the initial serology survey excluded the diagnosis of SLE initially. The diagnosis of lysinuric protein intolerance was established and SLE developed 1 year later. Renal manifestations in patients with LPI and the coexistence of LPI with SLE are reviewed.
Results The initial renal involvement in LPI included renal tubular dysfunction, nephritic and nephrotic syndrome. During follow-up, some patients developed renal function impairment and may progress to end stage renal disease. Glomerulus was the major involved lesion with the most common histological finding was immune complex glomerulonephritis. Five patients, including our patient, with LPI coexisted with SLE have been reported during follow-up. These patients characterised female predominant, young onset age, predominant renal involvement, and poor prognosis. Our patient supported the suggested mechanism of macrophage activation. Treatment with steroid and cyclosporine accordingly led to remission of nephritis.
Conclusions LPI was not only a disorder of amino acid wasting but also a complex multisystemic disease with aberrant immune responses. LPI-associated glomerulonephritis shares similar characteristics on renal histology with lupus nephritis. Both macrophage activation and excess arginine accumulation might play roles on the pathogenesis.
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