Lupus Nephritis

Question 1

Proliferative lupus nephritis histology

Answer 1

Subendothelial immune deposits/ wire loops around them
Hyper cellularity
Leukocyte infiltration
Fibrinoid necrosis/hyaline thrombi
IF deposition- deposits of IgG, C1q, C3, IgA,IgM

Question 2

Types of lupus nephritis

Answer 2

I - minimal mesangial LN (normal light microscopy)
II- mesangial proliferative
III- focal lupus nephritis
IV - diffuse lupus nephritis
v- pure membranous- controversial treatment
VI- advanced sclerosing lupus nephritis

Question 3

Mechanism mycophenolate

Answer 3

Inhibits inosine monophosohate dehydrogenase- anti proliferative

Question 4

MMF side effects

Answer 4

Pancytopaenia
Infection
Malignancy
Gi upset

Question 5

Maintenance lupus nephritis

Answer 5

MMF and AZA as effective as cyclophosphamide
At least 2 years
Recent trial showed MMF superior in maintaining renal remission

Question 6

Ritux role in LN

Answer 6

Probable role in severe refractory or relapsing disease