Lupus Nephritis Pathology Overview

Questions and Answers

Which type of lupus nephritis is associated with minimal renal manifestation and normal renal function?

Class II

What is the prognosis for patients with lupus nephritis limited to the renal mesangium?

Excellent, generally not needing therapy

Which class of lupus nephritis involves focal lesions with 90% sclerotic glomeruli and may lead to end-stage renal disease?

Class III

What percentage of lupus nephritis patients may require dialysis or transplantation due to end-stage disease?

20% Signup and view all the answers

When is renal transplantation typically performed in patients with renal failure from lupus nephritis?

~6 months of inactive disease Signup and view all the answers

What is the most common clinical sign of renal disease in patients with lupus nephritis?

Proteinuria Signup and view all the answers

Which antibodies correlate best with the presence of renal disease in lupus nephritis?

Anti-dsDNA antibodies Signup and view all the answers

What is a common feature seen in patients with acute lupus nephritis?

Hypocomplementemia Signup and view all the answers

Which WHO workshop outlined distinct patterns of lupus-related glomerular injury in 1974?

World Health Organization Signup and view all the answers

What is the purpose of performing a kidney biopsy in most patients with renal involvement in lupus nephritis?

To determine the histologic subtype Signup and view all the answers

Which classification provides the basis for modern treatment recommendations for lupus nephritis?

2004 classification of lupus-related glomerular injury Signup and view all the answers

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.