Renal infarction due to lupus vasculopathy

Area of Science:

• Nephrology
• Immunology
• Pathology

Background:

• The International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification for lupus nephritis (LN) does not explicitly include renal vascular lesions.
• Lupus vasculopathy, particularly in the postpartum setting, presents a diagnostic challenge.

Observation:

• A patient presented with postpartum lupus vasculopathy.
• Renal biopsy revealed concentric intimal thickening and luminal narrowing of arterioles without inflammatory changes.
• Immunoglobulin and complement deposition were observed on the arteriolar walls.

Findings:

• The observed arteriolar changes are indicative of lupus vasculopathy.
• Glomeruli exhibited diffuse proliferative glomerulonephritis, characterized by wire loops and a cellular crescent in one glomerulus.
• These pathological findings suggest a complex interplay between vascular and glomerular involvement in lupus nephritis.

Implications:

• This case underscores the importance of recognizing lupus vasculopathy as a distinct entity in lupus nephritis, even when not explicitly classified.
• The findings suggest that immunosuppressive therapy can be effective in managing postpartum lupus vasculopathy and associated glomerulonephritis.
• Further research into the classification and management of renal vascular lesions in lupus nephritis is warranted.