GLOMERULONEPHRITIS-LUPUS NEPHRITIS

SUMMARY

1. SLE produces renal disease in approx. 50% of patients.

2. Glomerular disease in SLE is divided into 6 patterns of glomerular injury.

3. Class III, IV, V lupus nephritis typically presents with decreased renal function & nephrotic syndrome.

4. Inx: urine mcs, casts, spot protein:creatinine ratio; serum EUC, dsDNA/C3/C4.

5. All lupus patients with an active urine sediment, regardless of GFR, are candidates for renal biopsy. Not for < 0.5g/day proteinuria & bland sediment, unless worsening kidney function.

6. Histology: glomerular deposits that stain predominantly for IgG and contain co-deposits of IgA, IgM, C3 and C1q (“full house” IF pattern), extraglomerular immune type deposits within TBM, interstitium and vessels.

7. Lupus nephritis should be treated aggressively with either mycophenolate mofetil or cyclophosphamide, in conjunction with steroids.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].