Podcast
Questions and Answers
Which type of lupus nephritis is associated with minimal renal manifestation and normal renal function?
Which type of lupus nephritis is associated with minimal renal manifestation and normal renal function?
What is the prognosis for patients with lupus nephritis limited to the renal mesangium?
What is the prognosis for patients with lupus nephritis limited to the renal mesangium?
Which class of lupus nephritis involves focal lesions with 90% sclerotic glomeruli and may lead to end-stage renal disease?
Which class of lupus nephritis involves focal lesions with 90% sclerotic glomeruli and may lead to end-stage renal disease?
What percentage of lupus nephritis patients may require dialysis or transplantation due to end-stage disease?
What percentage of lupus nephritis patients may require dialysis or transplantation due to end-stage disease?
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When is renal transplantation typically performed in patients with renal failure from lupus nephritis?
When is renal transplantation typically performed in patients with renal failure from lupus nephritis?
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What is the most common clinical sign of renal disease in patients with lupus nephritis?
What is the most common clinical sign of renal disease in patients with lupus nephritis?
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Which antibodies correlate best with the presence of renal disease in lupus nephritis?
Which antibodies correlate best with the presence of renal disease in lupus nephritis?
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What is a common feature seen in patients with acute lupus nephritis?
What is a common feature seen in patients with acute lupus nephritis?
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Which WHO workshop outlined distinct patterns of lupus-related glomerular injury in 1974?
Which WHO workshop outlined distinct patterns of lupus-related glomerular injury in 1974?
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What is the purpose of performing a kidney biopsy in most patients with renal involvement in lupus nephritis?
What is the purpose of performing a kidney biopsy in most patients with renal involvement in lupus nephritis?
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Which classification provides the basis for modern treatment recommendations for lupus nephritis?
Which classification provides the basis for modern treatment recommendations for lupus nephritis?
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Study Notes
Lupus Nephritis
- Minimal renal manifestation and normal renal function are typical for class I and II lesions, with nephrotic syndrome being rare.
Prognosis
- Patients with lesions limited to the renal mesangium have an excellent prognosis and generally do not need therapy for their lupus nephritis.
Classification
- Class III describes focal lesions involving 90% sclerotic glomeruli and ESRD with interstitial fibrosis.
- Up to 20% of patients with lupus nephritis will reach end-stage disease, requiring dialysis or transplantation.
Mortality and Transplantation
- Patients with lupus nephritis have a markedly increased mortality compared with the general population.
- Renal transplantation in renal failure from lupus usually results in allograft survival rates comparable to patients transplanted for other reasons, after ~6 months of inactive disease.
Pathophysiology
- Leukocyte infiltration, activation of procoagulant factors, and release of various cytokines contribute to renal injury.
- In situ immune complex formation also plays a role in renal injury, with immune deposits occurring in the mesangial, subendothelial, and/or subepithelial spaces.
Clinical Manifestations
- Proteinuria is the most common clinical sign of renal disease, but hematuria, hypertension, varying degrees of renal failure, and active urine sediment with red blood cell casts can also be present.
Diagnosis and Laboratory Findings
- Anti-dsDNA antibodies that fix complement correlate best with the presence of renal disease.
- Hypocomplementemia is common in patients with acute lupus nephritis (70–90%), and declining complement levels may herald a flare.
- A kidney biopsy should be performed in most patients with renal involvement to establish the histologic subtype, which guides therapy.
Classification Systems
- The World Health Organization (WHO) workshop in 1974 first outlined several distinct patterns of lupus-related glomerular injury, with modifications made in 2004.
- The latest classification system forms the basis for modern treatment recommendations.
Histologic Subtypes
- Class I nephritis describes normal glomerular histology by normal light microscopy with minimal mesangial deposits on immunofluorescent or electron microscopy.
- Class II designates mesangial immune complexes with mesangial proliferation.
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Description
This quiz provides an overview of the pathology of lupus nephritis, including mechanisms such as leukocyte infiltration, activation of procoagulant factors, and in situ immune complex formation. The focus is on immune deposits in different renal spaces and their clinical implications on disease presentation and treatment.
