Lupus nephritis

Lupus nephritis occurs in up to 50% of patients with SLE. It is a secondary glomerulopathy caused by immunocomplexes. Lupus nephritis is 1 of 11 criteria for confirming a diagnosis of systemic lupus − at least 4 criteria out of 11 are needed.

Symptoms and diagnosis

 * Acute renal failure is a rare, rather slow progression to insufficiency,
 * nephritic syndrome (hematuria, oligouria, azotemia, hypertension, proteinuria), nephrotic syndrome,
 * antibody positivity: ANAb, anti ds DNA, anti C1q,
 * biopsy of the kidneys is indicated in all patients with SLE who should have only a minimal urinary finding.

Types of lupus nephritis (WHO)
The individual types do not represent gradual stages, they are possible findings of nephropathy in SLE:
 * type I − normal finding,
 * type II - mesangial GN,
 * type III − focally proliferative GN − less than 50% of the glomeruli are affected,
 * type IV − diffusely proliferative GN − more than 50% of the glomeruli are affected,
 * type V − membranous GN,
 * type VI − diffuse sclerosing GN.

Therapy

 * type II − corticoids,
 * type III a IV − combined immunosuppression (corticoids + pulsed cyclophosphamide, azathioprim, mycophenolate mofetil or cyclosporin A) − this treatment is given for 3-6 months as an induction, the aim is to achieve remission and switch to maintenance therapy (corticosteroids + azathioprim for 1-3 years),
 * type V − corticoids + cyklophosphamide,
 * type VI − renal function replacement,
 * biologic therapy in refractory patients − rituximab (anti CD20).

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