Lupus Nephritis

Question 1

What is lupus nephritis?

Answer 1

Most dangerous specific manifestation of SLE because of its high morbidity and mortality
Can manifest as nephritic syndrome and or nephrotic syndrome

Question 2

What is the Pathophysiology of lupus nephritis?

Answer 2

Mesangial and or subendothelial deposition of immune complexes -> expansion and thickening of mesangium, capillary walls and or glomerular basement membrane

Question 3

What are the clinical features of lupus nephritis?

Answer 3

Huypertension
Oedema
Hematuria

Question 4

What is the diagnosis for lupus nephritis?

Answer 4

Lab studies - BMP - increased creatinine
Urinalysis - proteinuria, Hematuria, cellar casts (RBC’s, Hb, granular, tubular or mixed). Spot urine protein:creatinine ratio - proteinuria >.5g/g

Kidney biopsy - indicated in patients with either - unexplained increased creatinine, proteinuria >1g/g, proteinuria >.5g/g and Hematuria or cellular urinary casts . Findings - immune complex mediated glomerulonephritis

Question 5

What is the management of lupus nephritis?

Answer 5

General principles - all patients should receive standard therapy for lupus and individualised management of CKD

Pharmacological management - IV glucocorticoids, plus other immunosuppressants