Lupus Nephritis Flashcards
definition
inflammation of the nephron caused by systemic lupus erythematous
how many patients with SLE develop lupus nephritis
50%
PATHOPHYSIOLOGY
- in SLE there is defective immune clearance of nuclear material that has been released from apoptotic cells, so it is left hanging around for abnormally long lengths of time, therefore, the body starts to regard it as non-self and produces anti-nuclear antibodies in response
- at the nuclear antigens and the anti-nuclear antibodies form immune complexes which can travel within the blood to become lodged in the vessel of any part of the body where the induce an inflammatory reaction causing the activation of the complement system and the recruitment of neutrophils which release proteases which damage the endothelium
- in lupus nephritis they travel to the glomerulus and deposit causing damage
lupus nephritis is classified according to
the exact site of deposition of the immune complexes and the subsequent inflammatory reaction
most common site of deposition of immune complexes in lupus nephritis is
the endothelium but deposits can occur in the basement membrane, bowmans space or near the mesangial cells
the extent of inflammation caused by lupus nephritis can be
focal or diffuse
lupus nephritis most commonly presents as
a nephrotic syndrome but can present as a nephritic syndrome
classification of lupus nephritis
Class I = minimal mesangial Class II = mesangial proliferative Class III = focal proliferative Class IV = diffuse proliferative Class V = membranous Class VI = advanced sclerosing
diagnosis of lupus nephritis
Kidney biopsy
- deposition into bowman’s space of immune complexes causes the classic crescent shaped swelling
- deposition in the basement membrane causes thicker of the basement membrane giving rise to classic wire loop pattern
treatment of lupus nephritis
IV steroids and cyclophosphamide
