Uric Acid Nephropathy Superimposed on Lupus Nephritis

Abstract

Hyperuricaemia and gout are predominant diseases of middle-aged men and postmenopausal women. Systemic lupus erythematosus is primarily a disease of young women, with a female: male ratio of about 9:1. Uric acid nephropathy and lupus nephritis are often the cause of renal failure. The incidence and prevalence of these two diseases are low in young men. We report a 29-year-old man who presented with anasarca, gross hematuria, proteinuria, mild anaemia, hyperuricaemia and acute renal failure. He had developed a rash on his face and right hand, and pain in both knee joints six months prior to presentation. Gouty arthritis was diagnosed because of coexistent hyperuricaemia. He was admitted to hospital because of exacerbated anasarca which had been progressing slowly for over half a year. Severe proteinuria and hematuria were also noted and a renal biopsy revealed uric acid nephropathy superimposed on lupus nephritis. Long term medication with immunosuppressants and a uric acid-lowering agent were prescribed after the pathohistologic diagnosis. The patient's serum creatinine level had improved after six months of therapy.