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INTRODUCTION Lupus nephritis (LN) is a severe complication of Systemic Lupus Erythematosus (SLE). It typically presents in the first year after diagnosis and in up to 10% of cases will progress to chronic kidney disease (CKD). There is an important proportion of patients who debut with nephrotic syndrome, who by renal biopsy present a membranous glomerulonephritis with "Full-house" pattern by immunofluorescence, but serologically with negative antibodies.
OBJECTIVE To present a series of five cases with a diagnosis of class V "Full house" lupus nephritis with negative serology.
CASE SERIES Four women (31-44 years old) and one man (26 years old) who were admitted to hospitalization in Internal Medicine, over a period of three years, with nephrotic syndrome. Infectious causes were ruled out: Hepatitis B, C and HIV infection. Immunological profile was requested, highlighting: antinuclear antibodies (ANAs), anti-double-stranded anti-DNA antibodies, anti-Smith antibodies, anti-SSA antibodies (Ro 52 and Ro 60), anti-SSB antibodies, ANCA MPO antibodies and negative PR3. Serum complement (C3 and C4) was requested and reported normal. A renal biopsy was performed showing a membranous glomerulonephritis with "Full-house" immunocomplexes: IgG, IgA, IgM, C1q, C3c (3+). According to the ACR/EULAR 2019 classification criteria, the diagnosis of Lupus Nephritis class V "Full-House" was made. The patients are currently under follow-up by the Rheumatology and Nephrology service of our hospital.
CONCLUSION Class V "Full House" seronegative LN is a form of early atypical presentation without systemic manifestations of SLE, however, to date there is no consensus on this group of patients allowing an area of further research on its clinical presentation, disease progression and antibody positivization in the coming years. The importance lies in the initiation of induction and maintenance therapy to reduce the risk of progression to CKD.