Pediatric severe lupus nephritis detected by school urinary screening: a case report

Abstract Pediatric lupus nephritis (LN) often presents with severe histopathological features at diagnosis, frequently resulting in poor renal outcomes. Early detection remains challenging, particularly in cases presenting only urinary abnormalities. Herein, we report the case of a 15-year-old female diagnosed with class IV LN, initially identified through school urinary screening owing to the hematuria and proteinuria findings. Apart from elevated blood pressure and asymptomatic oral mucosal lesions, she displayed no other notable clinical signs or symptoms. Laboratory tests revealed hypocomplementemia, leukopenia, and the presence of autoantibodies. Class IV LN diagnosis was confirmed by findings consistent with full-house nephropathy and diffuse proliferative nephritis, by the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification criteria. Following 6 months of treatment with methylprednisolone pulse therapy, mycophenolate mofetil, hydroxychloroquine, and candesartan, the patient achieved complete renal remission. This case highlights the potential value of school urinary screening in the early detection and management of pediatric LN.