Clinicopathological Study of Nonlupus “Full-House” Nephropathy

Full-house staining of glomeruli in renal pathology is highly suggestive of lupus nephritis. Other nonlupus entities can also present with a similar pattern on immune fluorescence. Different authors have used different names for this new entity with full house staining on immunofluorescence (IF) with negative serology for lupus. Some authors used the term full-house nephropathy for this new entity. The aim of our study is to define the clinicopathological spectrum and treatment outcomes of nonlupus "full-house" patterns. We retrospectively reviewed all renal biopsies performed between 2013 and 2017 in the nephrology department in a tertiary teaching hospital in south India. A total of 12 patients were found with full-house staining on IF, not fulfilling the American College of Rheumatology criteria for SLE. Out of 12 patients, eight patients (66%) presented with features suggestive of both nephrotic and nephritic syndrome, one patient (8%) with subnephrotic proteinuria, one patient (8%) with rapidly progressive glomerulonephritis, one patient (8%) with pure nephrotic syndrome, and one patient (8%) with pure nephritic syndrome. The most common histopathology pattern observed was diffuse proliferative glomerulonephritis (58%), followed by membranous nephropathy (16%), membranoproliferative glomerulonephritis (16%), and mesangioproliferative glomerulonephritis (8%). Irrespective of treatment regimen given, six patients (50%) achieved complete remission, three patients (25%) achieved partial remission, and three patients (25%) did not attain remission at the end of six months. Only one patient became ANA positive during follow-up. Thus, we can conclude that varied glomerular pathologies can occur with full house pattern on IF which respond well to immunosuppression.