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5. CLASS V
- represented by diffuse membranous GN.
- On Light microscopy, thickening of the GBM is evident.
- EM reveals predominantly subepithelial deposits.
- Most (90%) of pts present with a nephrotic syndrome but
significant impairment of the GFR is unusual.
.
6. CLASS VI
- represents the end stages of proliferative lupus
nephritis and is characterized by diffuse glomerulo-
sclerosisand advanced tubulo-interstitial disease.
- Patients are often hypertensive, may have nephrotic
syndrome, and usually have impaired GFR.
SILENT LUPUS NEPHRITIS
- Although the renal lesion is mild in the majority of
patients with clinically silent lupus nephritis, several
reports have described severe proliferative GN in the
absence of proteinuria or abnorm of urinary sediment.
- Clinical Mx of these pts is uncertain.
CLINICAL COURSE OF SLE IN ESRD AND AFTER
TRANSPLANTATION
- Several reports indicate that even though pts may have
severe systemic dx and serological abnormalities at the
time renal dx progresses to RF, within a few months
clinical activity of non-renal SLE markedly decreases.
- A reduction in systemic manifestations and lack of
evidence of recurrent lupus nephritis have been
characteristic features of lupus pts treadted with renal
transplantation.
MANAGEMENT
Principle goals of therapy is to improve or prevent loss of
renal fxn and treatment must do the pt as little harm poss
1. Renal biopsy - if no contra-indications
2. Diet
3. Loop diuretics - to decrease oedema
4. Evaluate renal activity : urine sediment appearance,
serum creatinine, creat clearance, BP, serum alb, 24hr
urine prot, c3 complement, anti-DNA, urine dipstix.
5. Monitoring toxicity of steroids, diuretics and cytotoxic
agents : FBC, K+, gluc, chol, LFTs.
6. Aggressive Rx of Hypertension
7. Discourage pregnancy - increased risk of renal failure
8. Antimalarials if have active skin dx.
TREATMENT
1. GLUCOCORTICOIDS
2. PULSE STEROID THERAPY
3. CYTOTOXIC DRUGS
4. PLASMAPHARESIS
5. ANCROD
6. TOTAL LYMPHOID IRRADIATION
7. IMMUNOTHERAPY