Rapidly progressive glomerulonephritis: A wild card manifestation of lupus nephritis

A significant proportion of individuals with systemic lupus erythematosus (SLE) will have clinical or laboratory evidence of renal involvement at some point in the course of their disease. Lupus nephritis (LN) is one of the more important systemic manifestations of SLE and although progression to end-stage renal disease (ESRD) is not usually the norm, a significant minority of patients will do so, some in a rather dramatic fashion. It is in such instances that LN constitutes a true nephrologic emergency. Gratifyingly, it is rarely a silent emergency and heightened awareness amongst clinicians about its unpredictable course should lead to earlier recognition and intervention. For this reason, a case of LN presenting with historical and histologic evidence of chronic kidney disease and superimposed, acute acceleration of renal function decline, leading rapidly to ESRD is reported here. A brief review of the literature surrounding the pathophysiologic mechanisms, clinicopathologic characteristics and current therapeutic approaches to LN is subsequently explored.