Minimal change disease in systemic lupus erythematosus

We report the clinical and pathologic findings in 7 patients with sys- temic lupus erythematosus and minimal change disease. All 7 patients presented with full nephrotic syndrome including peripheral edema, nephrotic range proteinuria (mean 9.6 g/day), and hypoalbuminemia (mean 1.8 g/dl). In all cases, renal biopsy revealed diffuse foot process effacement in the absence of significant peripheral capillary wall im- mune deposits, findings consistent with mini- mal-change disease. In addition, 5 cases dis- played mesangial electron-dense deposits, with or without associated mesangial prolif- eration, consistent with underlying lupus nephritis class II. In all cases, steroid therapy induced a rapid remission of nephrotic syn- drome. Minimal change disease is an under- recognized and readily reversible form of nephrotic syndrome in systemic lupus ery- thematosus. Because it may occur superim- posed on mild mesangial proliferative lupus nephritis, this entity may be misinterpreted as an atypical presentation of lupus nephritis class II. Proper recognition of this entity re- quires careful integration of the renal biopsy immunofluorescence and electron micro- scopic findings.