Data Sheet 1_Case Report: Full-house renal-limited lupus-like nephritis in pregnancy.pdf

Lupus nephropathy is a common manifestation of systemic lupus erythematosus (SLE), with immune-mediated inflammatory damage to the glomerulus leading to acute kidney injury, chronic kidney disease, and end-stage renal disease. Occasionally, patients present with renal-limited lupus nephropathy with classic full-house staining on immunofluorescence and no signs of systemic lupus. Limited data are available on renal-limited “lupus-like nephropathy” in pregnancy. A 24-year-old G1P0 woman at 14 weeks of gestation was referred to nephrology for further evaluation of 8.4g proteinuria. She was found to be ANA negative with a decreased C1q level and a renal biopsy revealing membranous nephropathy. Immunofluorescence staining was positive for IgG, IgA, IgM, C3, and C1Q, consistent with full-house pattern. She was started on 500 mg pulse dose methylprednisolone for 3 days, which was gradually tapered to 5 mg daily, and cyclosporine 75 mg BID. She delivered a healthy baby via induction at 36 weeks. Six-month follow-up revealed 1g protein on 24-hour urine collection, normal C3/C4 levels, and no signs of SLE. This case report adds to the literature discussing renal-limited “lupus-like nephropathy” in pregnancy and helps guide further management of this condition.

狼疮性肾病是系统性红斑狼疮（systemic lupus erythematosus, SLE）的常见临床表现，由免疫介导的肾小球炎性损伤引发急性肾损伤、慢性肾病及终末期肾病。部分患者可表现为肾局限性狼疮性肾病，免疫荧光检测呈典型满堂亮染色（full-house staining），且无系统性红斑狼疮相关临床体征。目前关于妊娠期间肾局限性“类狼疮性肾病”的相关临床数据较为匮乏。本次报告的病例为一名24岁孕1产0（G1P0）、妊娠14周的女性，因24小时尿蛋白定量达8.4g转诊至肾病科进一步评估。检查结果显示其抗核抗体（antinuclear antibody, ANA）阴性，补体C1q水平降低，肾活检病理提示膜性肾病。免疫荧光染色显示IgG、IgA、IgM、C3及C1q均呈阳性，符合满堂亮图谱（full-house pattern）特征。患者接受了500mg甲泼尼龙冲击治疗3天，随后逐渐减量至每日5mg，并联合环孢素75mg每日两次给药。最终患者于妊娠36周时经引产娩出健康新生儿。随访6个月显示，其24小时尿蛋白定量为1g，补体C3、C4水平恢复正常，且未出现系统性红斑狼疮相关体征。本病例报告丰富了妊娠期间肾局限性“类狼疮性肾病”的相关文献资料，可为该病症的后续临床管理提供参考依据。