SLE: features/Renal complications

Question 1

SLE: features?

Answer 1

• Systemic lupus erythematosus (SLE) is a multisystem, autoimmune disorder.
• It typically presents in early adulthood and is more common in women and people of Afro-Caribbean origin.

General features:

• fatigue
• fever
• mouth ulcers
• lymphadenopathy

Question 2

Skin?

Answer 2

• malar (butterfly) rash: spares nasolabial folds
• discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas.
• Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic
• photosensitivity
• Raynaud’s phenomenon
• livedo reticularis
• non-scarring alopecia

Question 3

Other features?

Answer 3

Musculoskeletal

• arthralgia
• non-erosive arthritis

Cardiovascular

• myocarditis

Respiratory

• pleurisy
• fibrosing alveolitis

Question 4

Other features?

Answer 4

Renal

• proteinuria
• glomerulonephritis (diffuseproliferativeglomerulonephritis is the most common type)

Neuropsychiatric

• anxiety and depression
• psychosis
• seizures

Question 5

SLE: renal complications?

Answer 5

WHO classification:

• class I: normal kidney
• class II: mesangial glomerulonephritis
• class III: focal (and segmental) proliferative glomerulonephritis
• class IV: diffuse proliferative glomerulonephritis
• class V: diffuse membranous glomerulonephritis
• class VI: sclerosing glomerulonephritis

Question 6

Class IV (diffuse proliferative glomerulonephritis) is the most common and severe form. Renal biopsy characteristically shows the following findings:

Answer 6

• glomeruli shows endothelial and mesangial proliferation, ‘wire-loop’ appearance
• if severe, the capillary wall may be thickened secondary to immune complex deposition
• electron microscopy shows subendothelial immune complex deposits
• granular appearance on immunofluorescence

Question 7

Management?

Answer 7

• treat hypertension
• corticosteroids if clinical evidence of disease
• immunosuppressants e.g. azathiopine/cyclophosphamide

Question 8

Diffuse proliferative SLE. Proliferation of endothelial and mesangial cells. The thickening of the capillary wall results in a ‘wire-loop’ appearance. Some crescents are present.

Answer 8