A 60-year-old man who developed a nephrotic syndrome underwent a renal biopsy, and the case was diagnosed as membranoproliferative glomerulonephritis (MPGN). Despite chemotherapy using steroid, immunosuppresive and anticoagulant drugs, the patient exhibited persistently high urinary protein levels (above 8 g/day), and the renal function deteriorated gradually.
One and half years later, hemodialysis was started, but soon he had a high fever (above 38-40°C). Laboratory data revealed high levels of both antinuclear antibody titer and immune complex (IC) titer, and a low level of CH50.
Considering an active collagen disease like SLE, steroid pulse therapy and plasma exchange were instituted. The therapy was very effective this time.
It is well known that many patients with SLE and a long term history of hemodialysis develop a condition of so called “burn out” in which the activity of SLE declined to allow the withdrawal of steroid therapy. Also well known is the developement of hypocomplementemia in many patients with MPGN.
In our case, it was difficult to clarify what caused the high fever and other clinical symptoms. We must carefully observe the clinical symptoms of SLE.