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Nephrotic syndrome in procainamide induced lupus nephritis
Clinical Nephrology
|April 1, 1979
Summary
Procainamide can induce lupus-like syndrome (LE), leading to nephrotic syndrome. Steroid therapy resolved symptoms, and the condition did not recur after discontinuing the drug.
Area of Science:
- Nephrology
- Rheumatology
- Clinical Pharmacology
Background:
- Drug-induced lupus erythematosus (DILE) is a well-documented phenomenon.
- Procainamide is a known causative agent for drug-induced lupus.
- Nephrotic syndrome is a rare but serious complication of DILE.
Observation:
- A patient presented with nephrotic syndrome, bilateral pleural effusions, pericarditis, and fever.
- The patient had a positive lupus erythematosus (LE) cell preparation and high antinuclear antibody (ANA) titer.
- No anti-double-stranded DNA (anti-dsDNA) antibodies were detected.
Findings:
- Renal biopsy revealed mesangial proliferation with immunoglobulin M (IgM) and complement component 3 (C3) deposits.
- Electron microscopy identified subendothelial deposits in the kidneys.
- Clinical improvement was observed following steroid therapy.
Implications:
- This case highlights nephrotic syndrome as a potential renal manifestation of procainamide-induced lupus.
- Prompt diagnosis and withdrawal of the offending drug, along with immunosuppressive therapy, are crucial for management.
- Long-term outcomes can be favorable with appropriate treatment, as evidenced by the 24-month recurrence-free period.