Systemic onset juvenile rheumatoid arthritis (JRA) is a complex disease which affects many organ systems. Associated renal lesions are unusual, with the possible exception of amyloidosis. We describe a case of a girl with systemic onset JRA who first developed membranous nephropathy and then, three and a half years later, a severe crescentic glomerulonephritis.

The child presented at 5 1/2 years of age with the classic features of systemic onset JRA. As her disease was unresponsive to conventional therapies, she was given a therapeutic trial of intravenous immunoglobulin (IVIG). Within 2 weeks of this intervention, she developed proteinuria, which progressed to nephrotic syndrome. Renal biopsy revealed membranous nephropathy. The nephrotic syndrome resolved with steroid therapy and withdrawal of IVIG.

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