Study on all in-patients treated at Kidney Department of Bach Mai Hospital from 2000 to 2002, which divided into 2 groups: group 1 included 38 patients with lupus nephritis and nephrotic syndrome, group 2 included 45 patients with primary nephrotic syndrome (NS). Results: most of primary NS occurred before the age of 50 years old (95.6%), there was no difference between male and female. NS due to systemic lupus erythematosus (SLE) had multiple clinical signs and was more severe than in primary NS. The prevalence of renal impairment in both primary and secondary NS was high (44.4% and 55.3%, respectively). The serum protein concentration in primary NS was significant lower than secondary NS (p<0.01). Nevertheless, serum cholesterol, HDL-C, LDL-C concentrations in primary NS were significant higher than secondary NS (p<0.01). In primary NS, the rate of minimal change glomerulonephritis was highest (51.1%), but in secondary NS, mesangial proliferative glomerulonephritis accounted for highest rate (63.2%). In type IV in secondary NS due to SLE, there were symptoms of hypertension, renal failure, hemorrhage and the histological damages were more severe than in other types (p<0.05). Histological lesions in secondary membrane and mesangial proliferative glomerulonephritis due to SLE were more severe than primary diseases.
Nephrotic Syndrome, Lupus Erythematosus, Systemic, Adult, Diagnosis

Renal involvement is common in systemic lupus erythematosus (SLE). The typical lupus nephropathy demonstrates polyclonal immunoglobulin immune deposits with predominance of IgG, usually heavy polytypic complement factors C1q, C3 and C4. In SLE patients, the superimposition and occurrence of non- lupus nephropathy have rarely been reported. We describe a 28-year-old, 15 weeks pregnant women affected by SLE and IgA nephropathy. She was admitted to our hospital due to generalized edema and arthralgia. The ANA titer was 1: 640, anti-ds DNA levels were 354.2 U/mL and other blood tests included thrombocytopenia and hypoclomplementemia. These clinical and laboratory data allowed the diagnosis of SLE. Renal biopsy showed modest segmental mesangial hypercellularity. Immunofluorescence microscopy revealed distinct mesangial IgA and C3 with absence of IgG, IgM, C1q, and C4. Electron microscopy confirmed the presence of electron-dense deposits throughout the mesangium. These features were consistent with the coexistence of IgA nephropathy. A course of prednisolone (50 mg/day) was given for six months and she responded well with resolution of proteinuria. At the present follow- up time point (48 months), she continues to be treated with prednisolone (5 mg/day); proteinuria and ANA are undetectable.
Adult ; Arthralgia ; Biopsy ; Complement System Proteins ; Diagnosis ; DNA ; Edema ; Female ; Glomerulonephritis, IGA* ; Hematologic Tests ; Humans ; Immunoglobulin A* ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Microscopy, Electron ; Microscopy, Fluorescence ; Nephrotic Syndrome ; Prednisolone ; Pregnant Women ; Proteinuria ; Thrombocytopenia