Differential Diagnosis for SLE with Kidney Biopsy Showing Glomerulonephritis
- Single Most Likely Diagnosis
- Membranous Nephropathy: This is a common cause of nephrotic syndrome in patients with systemic lupus erythematosus (SLE) and can be associated with glomerulonephritis. The presence of SLE increases the likelihood of membranous nephropathy due to the autoimmune nature of the disease, which can affect the kidneys in various ways, including the formation of immune complexes that deposit in the glomerular basement membrane.
- Other Likely Diagnoses
- FSGS (Focal Segmental Glomerulosclerosis): While FSGS is a common cause of nephrotic syndrome in the general population, it can also be seen in SLE patients, either as a primary process or secondary to other glomerular injuries. The presence of FSGS in SLE might indicate a more chronic or secondary form of glomerular damage.
- Membranoproliferative GN: This is another pattern of glomerular injury that can be seen in SLE, characterized by the deposition of immune complexes and complement factors, leading to glomerular inflammation and proliferation. It is less common than membranous nephropathy in SLE but still a significant consideration.
- Do Not Miss Diagnoses
- Lupus Nephritis Class III or Class IV: These classes of lupus nephritis, as defined by the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification, involve focal or diffuse proliferative glomerulonephritis, respectively. They are critical to identify because they require aggressive immunosuppressive treatment to prevent progression to end-stage renal disease. Missing these diagnoses could lead to inadequate treatment and poor outcomes.
- Rare Diagnoses
- IgA Nephropathy: Although IgA nephropathy is a common cause of glomerulonephritis worldwide, it is less commonly associated with SLE. However, it can coexist with SLE or present with similar clinical features, making it a rare but possible diagnosis in this context.
- ANCA-Associated Vasculitis: This is a group of diseases characterized by the presence of anti-neutrophil cytoplasmic antibodies (ANCA) and can cause rapidly progressive glomerulonephritis. While rare in the context of SLE, it's crucial to consider due to its aggressive nature and the need for prompt treatment.