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Histoplasmosis - Abdominal
Joseph Junewick, MD FACR
over 4 years ago
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ARSt Case Repository

Lupus Nephritis

Case Detail

Anatomy: Genitourinary
Borders
Heather Borders, MD
Diagnostic Category: Infectious-Inflammatory
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: US CT
Activities:
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History

15 year old female with multiorgan involvement of SLE with overlap with MCT disease. Dermopathy, hepatitis, pancreatitis, nephropathy, coagulopathy, pancytopenia, myositis. Received pulse of solumedrol. Serum creatinine is 1.28 mg/dl. Protein/creatinine ratio is 1.7. C3 is 47, C4 is 15 and CH50 is 31. RF is 497 U/ml (normal is less than 25). Cardiolipin negative. ESR is 83. CRP is 26.4. Positive ANA, and RF. DNA pending.


Case Images


Diagnosis

Lupus nephritis, biopsy compatible with grade I mesangial lupus nephritis.

Findings

US-Echogenic cortex with peripheral hypoechoic rim and loss of corticomedullary differentiation.
CT-Heterogeneous, enlarged kidneys with rim of normal density tissue and a few wedge shaped areas of low density.
CT head-Multiple punctate parotid calcifications.

Discussion

The hypoechoic cortical rim is reported in lupus nephritis, possibly due to cortical interstitial edema. Differential includes cortical necrosis, cystic renal disease.

Additionally, a pattern of multifocal round or wedge shaped cortical foci of decreased echogenicity is reported, likely due to vasculitis and active interstitial inflammation. Differential for this pattern is pyelonephritis, infarcts or neoplasm.

Ultrasound images in this patient show the hypoechoic cortical rim. Focal areas of decreased echogenicity were not identified on ultrasound. However, the CT demonstrated focal areas of decreased density, likely due to infarct and vasculitis.

Reference

Journal of Ultrasound in Medicine, Vol 6, Issue 2 75-79, American Institute of Ultrasound in Medicine

The hypo-echoic cortical rim in lupus nephritis
S P SLATER MB, ChB, C A HELLER FRCR, R S NANRA FRCP,
W S JONES ARMIT, DMU
Australasian Radiology Volume 38, Issue 1, pages 46–47, February 1994



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