SLE Flashcards
what is the immunology?
ANA +ve
anti-dSDNA ab (70%)
complement - low levels
differential diagnosis
sjorgen's fibromyalgia primary APL thrombotic micro-angiopathies
what is the renal involvement in lupus?
lupus nephritis
what proportion of SLE patients get lupus nephritis?
50% of lupus patients at presentation
50% develop lupus involvement
how does it normally present?
proteinuria
can be different disease so get renal biopsy
class I
minimal mesangial involvement
extra-renal manifestations treated rather than renal
class II
mesangial proliferative
< 1mg proteinuria: no specific renal treatment
>3mg proteinuria: steroids/CNI - Calcineurin inhibitors
class III
focal proliferative
steroids + cyclophosphamide/ MMF
maintenance: aziathrioprine/MMF + low steroids for 1 year
class IV
diffuse proliferative
steroids + cyclophosphamide/ MMF
maintenance: aziathrioprine/MMF + low steroids for 1 year
class V
membranous
if normal kidney function and non-nephrotic range proteinuria: conservative
if persistent proteinuria - steroids + cyclophosphamide and/or MMF/azathioprine
class VI
advanced sclerosing
what treatment should all patients with lupus nephritis be on?
hydrochloroquine
