Recurrent Hematuria Unveiling Class V Lupus Nephritis in a Child: A Diagnostic Challenge Publisher



Ghorbanikhosroshahi N ; Javadi V ; Nili F ; Gholamalimajdabadi H ; Mohkam M ; Azad G
Source: Journal of Pediatric Perspectives Published:2025

Abstract

Background: Lupus nephritis (LN) is a serious renal complication of systemic lupus erythematosus (SLE), particularly in the pediatric population. It often presents with persistent hematuria and proteinuria, which can overlap with other glomerular disorders. This case report highlights the diagnostic challenges associated with LN in the presence of nonspecific clinical features. Case presentation: A 4-year-old boy was admitted for evaluation of persistent recurrent gross hematuria, which continued despite previous surgery for suspected urethral stricture. Initial laboratory tests showed significant hematuria, proteinuria, and mildly elevated inflammatory markers, raising concerns for nephritis. The patient was initially diagnosed with post-streptococcal glomerulonephritis (PSGN), but this was later excluded. A renal biopsy revealed membranous glomerulonephritis (MGN) stage I-II, and further immunological testing, including antinuclear antibodies (ANA) and anti-dsDNA antibodies, led to the final diagnosis of lupus nephritis class V. The findings were consistent with systemic lupus erythematosus, confirming the diagnosis. Conclusion: We report a pediatric patient diagnosed with Class V lupus nephritis based on renal biopsy, presenting with recurrent hematuria. This case emphasizes the importance of early nephrology consultation, serial testing, and renal biopsy for accurate diagnosis and appropriate management. © 2025, Mashhad University of Medical Sciences. All rights reserved.