Description 4 CASES with clinical manifestations of systemic lupus erythematosus (SLE) and proteinuria in nephrotic range. Case 1, a 30-year-old woman with multiple sclerosis history, using β1 interferon for 16 years, present dyspnea, delirium, edema in the lower limbs, hypertension, lymphopenia, thrombocytopenia, active sediment, 2.8 g/24 hrs. proteinuria, hypocomplementemia, ANA and anti-DNA+. Case 2, a 40-year-old woman with no medical history, arthritis, non-scarring alopecia, oliguria, and emergency hemodialysis criteria, anemia, hypocomplementemia, 0.5 g/24 hrs. proteinuria, ANA, and anti-DNA +. Case 3, a 46-year-old woman with no previous history, high blood pressure, leukocytoclastic vasculitis, edema in the lower limbs, anemia, thrombocytopenia, active sediment, 0.6 g/24 hrs. proteinuria, ANA, lupus anticoagulant, and SSA +. Case 4, a 39-year-old woman with no medical history, non-scarring alopecia, malar erythema, emergency hemodialysis criteria, lymphopenia, anemia, hypocomplementemia, 4.1 g/24 hrs. proteinuria, ANA, and anti-DNA +. The clinical manifestations are summarized in (table 1) according to the SLE EULAR/ACR 2019 classification criteria. Renal biopsy was performed in 4 cases (table 1), the first being associated with the long-standing use of Interferon β1, the second with star fruit consumption, the third with antiphospholipid syndrome, and the fourth ANCA-Associated Vasculitis (figure 1). The treatment and evolution of the patients 8 weeks after identification are shown in (table 1.)
Conclusions Glomerulopathy in SLE is a frequent and severe manifestation, so timely treatment is necessary. However, the role of renal biopsy becomes important despite the clinical characteristics, where its performance shows us that in the clinical spectrum of glomerulopathies not everything is Lupus.
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