{
  "abstract": "Background: The underlying pathophysiological mechanisms of proteinuria relapse in lupus nephritis (LN) patients during immunological remission are complex, often involving non-immune complex-mediated podocyte injury.\n\nCase presentation: We report a 21-year-old male with class IV LN and thrombotic microangiopathy (TMA). After multi-target induction and maintenance therapy, the patient achieved complete clinical remission. During subsequent follow-up, he developed progressive nephrotic-range proteinuria while maintaining serological remission (persistently negative autoantibodies and normal complement levels). Intensification of conventional immunosuppressants was ineffective. A repeat kidney biopsy revealed significant resolution of immune complex deposits but prominent focal segmental glomerulosclerosis (FSGS)-like changes with extensive podocyte foot process effacement. The regimen was adjusted to a podocyte-targeted therapy centered on tacrolimus, resulting in a rapid and sustained reduction in proteinuria.\n\nConclusion: This case suggests that in the clinico-serological dissociation phase of LN, repeat kidney biopsy is of significant clinical value for identifying pathological phenotypic shifts, avoiding excessive immunosuppression, and guiding precision medicine.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University"
  ],
  "article_type": "research support, non u.s. gov't",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zhifa Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jinxiu Deng"
    },
    {
      "affs": [
        0
      ],
      "name": "Jinfeng Shen"
    },
    {
      "affs": [
        0
      ],
      "name": "Hui Jiang"
    },
    {
      "affs": [
        0
      ],
      "name": "Fuzhen Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9kap0h0sm1ywz.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1941706",
  "fulltext_url": "https://europepmc.org/articles/PMC13680228",
  "id": "9kap0h0sm1ywz",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1941706/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2745|Systemic Lupus Erythematosus Research"
    ]
  ],
  "openalex": "W7220650493",
  "pdf_url": "https://europepmc.org/articles/PMC13680228?pdf=render",
  "pmcid": "PMC13680228",
  "pmid": "42903163",
  "published": "2026-10-06",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/9kap0h0sm1ywz.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:15Z",
      "native_id": "10.3389/fimmu.2026.1941706",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1941706/full"
    },
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42903163",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42903163"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    }
  ],
  "title": "Phenotypic shift from active class IV lupus nephritis to lupus podocytopathy: a case report highlighting the treatment-altering role of repeat kidney biopsy",
  "title_text": "Phenotypic shift from active class IV lupus nephritis to lupus podocytopathy: a case report highlighting the treatment-altering role of repeat kidney biopsy",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/9kap0h0sm1ywz",
  "venue": "Frontiers in Immunology",
  "versions": []
}