Sequential renal biopsy in a patient with lupus nephritis and fingerprint deposits: a case report

AbstractWe report a 38-year-old Japanese man in whom lupus membranous nephropathy was diagnosed by renal biopsy. Steroid therapy was initiated, followed by cyclophosphamide and calcineurin inhibitors. Although serum markers for the activity of lupus nephritis (LN) showed improvement, his renal function gradually declined. During this period, renal biopsy was repeated three times whenever proteinuria increased, revealing progression of lupus membranous nephropathy with an increase of epithelial immune deposits. Electron microscopy of the first biopsy specimen did not clearly show subepithelial fingerprint deposits, but these structures were better-defined at the second biopsy. The number of bands in the deposits was larger at the third biopsy and increased to a maximum of 25 at the fourth biopsy. These findings indicate that fingerprint deposits may be related to chronic change or disease activity of lupus membranous nephropathy, but the changes of these deposits were not consistent with those of serum mar...