A 42-year-old woman reported a two-week history of generalized fatigue, arthralgia, and a malar rash. She subsequently sought evaluation by her primary care physician, where abnormal urinalysis findings, including proteinuria and hematuria, were identified.
Previous diagnoses:
Arterial hypertension
Vital parameters:
BP: 145/85 mmHg
HR: 88/min
SpO2: 97 %
Physical examination:
Skin: Malar rash present; no purpura
Heart: clear, rhythmic
Lungs: vesicular breathing on both sides
Abdomen: soft, regular bowel sounds, no tenderness
Laboratory:
Hemoglobin (12.4–16.1) g/dL: 9.8
White blood cells: (4.0–11.8) Mrd/L: 3.5
Albumin (34–50) g/L: 32
Creatinine (0.7-1.2) mg/dL: 1.8
GFR (CKD-EPI) mL/min: 32
CrP (< 5) mg/L: 6.8
Immunology:
C3 (90-170) mg/dL: 38
C4 (12-36) mg/dL: 7
ANA (< 1:80) Titer: 1:640
Anti-dsDNA antibody: 80 IU/ml
c-ANCA (< 1:20): negative
p-ANCA (< 1:20): negative
GBM-AB (< 7) U/mL: negative
Urine:
Urine protein-creatinine ratio (uPCR) mg/g: 3850
Urine sediment:
Numerous red blood cells, including acanthocytes; few leukocytes; positive granular casts; and occasional cellular casts
The patient exhibited hematuria, heavy proteinuria, malar rash, arthralgia, pancytopenia, hypocomplementemia, and a positive anti–dsDNA antibody, all strongly suggestive of systemic lupus erythematosus.
Based on these clinical and immunological features, lupus nephritis was strongly suspected, and a renal biopsy was deemed indicated.
Note related to annotations: To avoid obscuring the lesions, the annotations are deliberately positioned close to, but not directly over, the lesion areas.