Minimal Change Nephrotic Syndrome in Two Patients with Suspected Systemic Lupus Erythematosus: Association or Co-Incidence

Systemic lupus erythematosus (SLE) is characterized by the production of pathogenic autoantibodies and the deposition of immune complexes in various organs, whereas minimal change disease (MCD) is characterized by normal or only mild mesangial cell proliferation without deposition of immune complexes. Although these two diseases are so different, they all share the same characteristics of dysregulation of T-lymphocyte and the appearance of low T4/T8 ratio. In this report, we present two cases who had (suspected) SLE developed minimal change NS (MCNS). Case 1 was diagnosed to have SLE, which fulfilled 5 revised SLE criteria of American College of Rheumatology (ACR), but MCD was shown in renal biopsy. Transient renal insufficiency was also noted. Case 2 had NS as well. Renal pathology revealed MCD and tubuloreticular inclusion. High titer of ANA developed later, and the diagnosis of SLE was highly suspected. Both cases got remission from NS after receiving steroid therapy. Since evidence supports that MCNS might be associated or related with SLE, the therapeutic strategy (corticosteroid) is suggested to treat as primary MCNS. Proper recognition of this entity by renal biopsy should be taken into consideration in SLE patient with NS.