Nephrotic State as the Chief Manifestation of Systemic Lupus Erythematosus

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Abstract
This report describes 2 cases of systemic lupus erythematosus (SLE), in which the clinical manifestations were chiefly those of the nephrotic syndrome. A diagnosis of systemic lupus erythematosus was not suspected while the patients were alive, and no lupus erythematosus cell preparations were made. The correct diagnosis was established only when post-mortem examination showed changes typical of this disease, even though a renal biopsy was performed in one case. The biopsy specimen contained only 5 glomeruli, and although in retrospect the microscopic appearance was compatible with systemic lupus erythematosus, it was not diagnostic of it Had the specimen been adequate, the true nature of the disorder might have been recognized. Nonetheless, the authors consider renal biopsies to be extremely valuable. The patient who underwent renal biopsy was treated with relatively large doses of gluco-corticoids (triamcino-lone, 64 mg daily for 2 weeks, followed by prednisone, 100 mg daily for 2 weeks). Sudden withdrawal of treatment was followed in 72 hours by severe pulmonary angiitis and death. It is suggested that great caution be used in discontinuing gluco-corticoid therapy in patients with nephrotic states, inasmuch as undiagnosed systemic lupus erythematosus may exist.