Lupus nephropathy as the initial manifestation of systemic lupus erythematosus.

The present report documents the occurrence of lupus nephropathy as the sole initial manifestation of systemic lupus erythematosus (SLE). Despite the absence of initial systemic signs characteristic of SLE, the diagnosis was confirmed on the basis of the renal histopathologic features and serological studies. Subsequent follow-up demonstrated systemic features of the disease in each of the four patients. The report shows that the diagnostic criteria for SLE proposed by the American Rheumatology Association may not be fulfilled at the time of the initial evaluation in all cases, and that some patients may exhibit signs attributable to primary renal disease. These data emphasize the importance of careful assessment of the pattern of glomerular ultrastructural changes and usefulness of appropriate serological studies.