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ANA-Negative Class V Lupus Nephritis with Isolated Anti-Smith Antibody Positivity: A Case Report
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DOI：10.7860/JCDR/2026/87313.23120.png)
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Abstract
En 中文
Lupus Nephritis (LN) is a severe manifestation of Systemic Lupus Erythematosus (SLE) and is typically associated with Antinuclear Antibody (ANA) positivity. ANA-negative LN is exceedingly rare and may delay diagnosis, especially when renal disease is the initial presentation. We report a case of a 38-year-old woman presenting with nephrotic syndrome who was diagnosed with biopsy-proven pure Class V LN despite repeatedly negative ANA and anti-double-stranded DNA antibodies. Extended serological testing revealed strongly positive anti-Smith (anti-Sm) antibodies with markedly reduced complement levels. The patient achieved partial remission following treatment with Mycophenolate Mofetil (MMF) and corticosteroids. This case highlights the diagnostic importance of renal biopsy and extended Extractable Nuclear Antigen (ENA) testing in suspected SLE with negative ANA serology and underscores the need for heightened clinical suspicion in atypical presentations.
Keywords:
Autoantibodies
Glomerulonephritis
Hypocomplementaemia
Immune complex diseases
Renal biopsy
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