Case report

A 15-year-old girl presented with recurrent arthritis, arthralgia and episodes of high temperature for 5 months. In the last 2 months, she developed crampy abdominal pain, nausea, episodes of diarrhoea without bleeding and paraesthesia in the hands and feet. Treatment with analgetics and physiotherapy only slightly ameliorated the symptoms. Thereafter she developed haematuria, proteinuria and increased serum creatinine and was admitted to hospital, showing a reduced general condition, conjunctivitis, exanthema at the back of the feet and hands, painful wrist swelling and mild oedema. Laboratory investigations showed anaemia, leucopenia, reduced serum C3 and C4 complement, reduced albumin, increased creatinine (1.21 mg/dl), CRP (6 mg/dl) and d-dimers (4.1 mg/l). Urine analysis revealed gross glomerular proteinuria (9 g/day) and haematuria (400 erythrocytes/μl; 28% dysmorphic). Serologically, antinuclear antibody (ANA,1:5120) and anti-ds DNA antibody titres (>200 U/ml) were elevated, positive cardiolipin antibodies (28 GPL-U/ml) were detected, while anti-neutrophil cytoplasmatic antibodies, anti-GBM, antistreptolysin and infectious serology were negative. Taken together, SLE was suspected, and a kidney biopsy was performed. Twenty-two markedly hypercellular glomeruli with increased mesangial and endothelial cell number (intracapillary proliferations) and cellular …