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Immune Complex Glomerulonephritis: A Rare Presentation in Systemic Sclerosis.

Govind S Shiddapur1, Md Amjad

  • 1Department of Internal Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India.

Annals of African Medicine
|April 7, 2026
PubMed
Summary

Systemic sclerosis rarely causes immune complex-mediated glomerulonephritis, not scleroderma renal crisis. Early renal biopsy is crucial for diagnosing atypical kidney issues in SSc patients.

Keywords:
Biopsie rénaleDiagnosischevauchementcomplexes immunsdiagnosticglomerulonephritisglomérulonéphrite àimmune complex-mediated glomerulonephritisoverlaprenal biopsysclérodermie systémiquesystemic sclerosis

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Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • Systemic sclerosis (SSc) commonly presents with renal involvement as scleroderma renal crisis (SRC).
  • Immune complex-mediated glomerulonephritis (GN) is an extremely rare renal manifestation in SSc.
  • This rarity can impede timely diagnosis and management of SSc-associated kidney disease.

Purpose of the Study:

  • To report a rare case of SSc presenting with immune complex-mediated GN.
  • To highlight the importance of considering alternative renal diagnoses beyond SRC in SSc.
  • To emphasize the diagnostic value of early renal biopsy in atypical SSc renal presentations.

Main Methods:

  • Case report of a 40-year-old woman with hypertension and Raynaud's phenomenon.
  • Clinical evaluation including laboratory tests (renal function, proteinuria, hematuria, complement C3), autoimmune markers (ANA, Scl-70), and imaging (ultrasound, echocardiography).
  • Renal biopsy with immunofluorescence analysis and histopathology.

Main Results:

  • The patient exhibited rapidly deteriorating renal function, nephrotic-range proteinuria, hematuria, and borderline low C3.
  • Autoimmune analysis was positive for speckled ANA and Scl-70.
  • Renal biopsy revealed diffuse proliferative GN with IgG and C3 immune deposits, excluding SRC and thrombotic microangiopathy.

Conclusions:

  • Systemic sclerosis can present with atypical renal manifestations like immune complex-mediated GN.
  • Diagnosing renal dysfunction in SSc requires considering conditions other than SRC.
  • Early renal biopsy is essential for accurate diagnosis and guiding individualized treatment in SSc patients with unusual kidney involvement.