Lupus nephritis

From WikiLectures

Lupus nephritis occurs in up to 50% of patients with SLE. It is a secondary glomerulopathy caused by immunocomplexes. Lupus nephritis is 1 of 11 criteria for confirming a diagnosis of systemic lupus − at least 4 criteria out of 11 are needed.

Symptoms and diagnosis[edit | edit source]

  • Acute renal failure is a rare, rather slow progression to insufficiency,
  • nephritic syndrome (hematuria, oligouria, azotemia, hypertension, proteinuria), nephrotic syndrome,
  • antibody positivity: ANAb, anti ds DNA, anti C1q,
  • biopsy of the kidneys is indicated in all patients with SLE who should have only a minimal urinary finding.

Types of lupus nephritis (WHO)[edit | edit source]

Glomerulonephritis

The individual types do not represent gradual stages, they are possible findings of nephropathy in SLE:

  • type I − normal finding,
  • type II - mesangial GN,
  • type III − focally proliferative GN − less than 50% of the glomeruli are affected,
  • type IV − diffusely proliferative GN − more than 50% of the glomeruli are affected,
  • type V − membranous GN,
  • type VI − diffuse sclerosing GN.

Therapy[edit | edit source]

  • type II − corticoids,
  • type III a IV − combined immunosuppression (corticoids + pulsed cyclophosphamide, azathioprim, mycophenolate mofetil or cyclosporin A) − this treatment is given for 3-6 months as an induction, the aim is to achieve remission and switch to maintenance therapy (corticosteroids + azathioprim for 1-3 years),
  • type V − corticoids + cyklophosphamide,
  • type VI − renal function replacement,
  • biologic therapy in refractory patients − rituximab (anti CD20).


Links[edit | edit source]

Related articles[edit | edit source]

References[edit | edit source]

  • RYŠAVÁ, Romana. Secondary glomerulonephritis [lecture for subject Nephrology, specialization General medicine, the 1st Faculty of medicine Charles University in Prague]. Prague. 2011-01-07. 



Kategorie:Nefrologie