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Nephritis Lupus

Definition
Systemic lupus erythematosus (SLE) is an autoimmune disease that
results in chronic inflammation and damage of more than one organ. It
is diagnosed clinically and serologically with the presence of
autoantibodies. One common manifestation that should be monitored
for in SLE is involvement of the kidneys, known as lupus nephritis (LN).
Epidemiology
• It usually found in more than 30% of patients who are diagnosed with SLE.
About 10 to 20% of patients may progress to ESRD.
• The incidence of lupus nephritis in the US is greater than Europe.
• Male gender is a risk factor for developing LN in addition to young adult
age.
• Children usually have the more severe form of lupus nephritis in
comparison to older adults and elderly.
• LN has a higher occurrence in the following racial ethnicities: Hispanics,
blacks, and Asians. It occurs less in whites. S
• ocioeconomic status has an impact on LN disease course. Poor
socioeconomic status is associated with a poorer prognosis of LN.
Etiology and Pathophysiology
• Lupus nephritis is a common manifestation of SLE. It is primarily
caused by a type-III, hypersensitivity reaction, which results in the
formation of immune complexes
• These immune complexes deposit on the mesangium, subendothelial,
and/or subepithelial space near the glomerular basement membrane
of the kidney. This leads to an inflammatory response with the onset
of lupus nephritis, in which the complement pathway is activated
with a resultant influx of neutrophils and other inflammatory cells.
Clicinal Manifestation
• Patients with lupus nephritis already have varying clinical
manifestations of SLE.
• Lupus nephritis is diagnosed through laboratory findings, such as
proteinuria or cellular casts.
• Early signs of proteinuria -> foamy urine or nocturia.
• If the degree of proteinuria meets the nephrotic syndrome criteria of
more than 3.5 grams per day of protein excretion, then peripheral
edema develops due to hypoalbuminemia.
• There may also be microscopic hematuria that is not grossly visible.
Diagnosis
• Laboratory
Screening for proteinuria and hematuria is recommended every three
months in active SLE.
• Radiographic
Bilateral kidney ultrasound should be obtained to rule out
hydronephrosis or obstructive cause.
• Biopsy
A kidney biopsy is indicated when the patient develops nephrotic range
proteinuria.
Treatment
Prognosis
• Prognosis depends on how early therapy is initiated. The earlier the
therapy is started in the disease course then, the better the disease
outlook in lupus nephritis.