{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:53:56Z","timestamp":1791262436249,"version":"4.1.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1941706","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:25:50Z","timestamp":1791260750000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenotypic shift from active class IV lupus nephritis to lupus podocytopathy: a case report highlighting the treatment-altering role of repeat kidney biopsy"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhifa","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinxiu","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuzhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2017.85","article-title":"Redefining lupus nephritis: Clinical implications of pathophysiologic subtypes","volume":"13","author":"Yu","year":"2017","journal-title":"Nat Rev Nephrol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.10.017","article-title":"Update on lupus nephritis: Core curriculum 2020","volume":"76","author":"Parikh","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215089","article-title":"2019 update of the EULAR recommendations for the management of systemic lupus erythematosus","volume":"78","author":"Fanouriakis","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2017090958","article-title":"Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach","volume":"29","author":"De Vriese","year":"2018","journal-title":"J Am Soc Nephrol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8091340","article-title":"Podocyte injury in lupus nephritis","volume":"8","author":"Sakhi","year":"2019","journal-title":"J Clin Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2019.08.011","article-title":"Lupus podocytopathy: An overview","volume":"26","author":"Oliva-Damaso","year":"2019","journal-title":"Adv Chronic Kidney Dis"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01880216","article-title":"Lupus podocytopathy: A distinct entity","volume":"11","author":"Bomback","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa129","article-title":"Per-protocol repeat kidney biopsy portends relapse and long-term outcome in incident cases of proliferative lupus nephritis","volume":"59","author":"Parodis","year":"2020","journal-title":"Rheumatology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.kint.2021.05.021","article-title":"KDIGO 2021 clinical practice guideline for the management of glomerular diseases","volume":"100","author":"Rovin","year":"2021","journal-title":"Kidney Int"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/nm.1857","article-title":"The actin cytoskeleton of kidney podocytes is a direct target of the antiproteinuric effect of cyclosporine a","volume":"14","author":"Faul","year":"2008","journal-title":"Nat Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12659\/AJCR.937201","article-title":"Tacrolimus induction therapy for nephrotic syndrome caused by minimal mesangial lupus nephritis with lupus podocytopathy: A case-based review","volume":"23","author":"Kurihara","year":"2022","journal-title":"Am J Case Rep"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00578-X","article-title":"Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): A double-blind, randomised, multicentre, placebo-controlled, phase 3 trial","volume":"397","author":"Rovin","year":"2021","journal-title":"Lancet"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1941706\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:25:51Z","timestamp":1791260751000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1941706\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":12,"alternative-id":["10.3389\/fimmu.2026.1941706"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1941706","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"article-number":"1941706"}}