Epitope Spreading: The Underlying Mechanism for Combined Membranous Lupus Nephritis and Anti-GBM Disease?

Membranous lupus nephritis associated with anti-GBM antibodies is a rare entity, particularly in lupus nephritis patients who are serologically negative for ANA and anti-dsDNA with normal complement levels. We present an unusual case of a patient initially diagnosed with anti-GBM disease whose repea...

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Bibliographic Details
Published in:Case reports in nephrology 2023-01, Vol.2023, p.1-6
Main Authors: Sogbein, Olusola, Kochar, Tina, Afrouzian, Marjan
Format: Article
Language:English
Subjects:
Antibodies
Biopsy
Blood
Case Report
Case reports
Creatinine
Disease
Genes
Lupus
Medical research
Microscopy
Neutrophils
Patients
Serology
Urine
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Summary:Membranous lupus nephritis associated with anti-GBM antibodies is a rare entity, particularly in lupus nephritis patients who are serologically negative for ANA and anti-dsDNA with normal complement levels. We present an unusual case of a patient initially diagnosed with anti-GBM disease whose repeat biopsy demonstrated combined focal proliferative and membranous lupus nephritis (III + V). The first biopsy showed a granular linear pattern, and the second biopsy had multiple electron dense deposits in the subendothelial, epithelial, and mesangial regions along with podocyte effacement. Experimental research suggests that the sequential histopathological transition observed may reflect the action of immunological rearrangement and epitope spreading.
ISSN:2090-6641
2090-665X
DOI:10.1155/2023/3190042