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Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus
Systemic lupus erythematosus

Systemic lupus erythematosus is a chronic Autoimmunity connective tissue disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body?s cells and tissue, resulting in inflammation and tissue damage....
 (SLE), a disease of the immune system
Immune system

An immune system is a collection of biological processes within an organism that protects against disease by identifying and killing pathogens and tumour cells....
. Apart from the kidneys, SLE can also damage the skin
Skin

The skin is the outer covering of the body, also known as the epidermis. It is the largest organ of the integumentary system made up of multiple layers of epithelial biological tissue, and guards the underlying muscles, bones, ligaments and organ s....
, joints, nervous system
Nervous system

The nervous system is a Neural network of specialized cells that communicate information about an animal's surroundings and itself. It processes this information and causes reactions in other parts of the body....
 and virtually any organ or system in the body.

erers of lupus nephritis may or may not have symptoms of kidney disease, but it can manifest itself through weight gain, high blood pressure
Hypertension

Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated....
, darker foamy urine
Urine

Urine is a liquid waste product of the body secreted by the kidneys by a process of filtration from blood called urination and excreted through the urethra....
 or swelling
Edema

File:Oedema.jpgEdema or Oedema , formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body....
 around the eyes, legs, ankles or fingers.

Histologically a wire-loop lesion will be present.






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Encyclopedia


Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus
Systemic lupus erythematosus

Systemic lupus erythematosus is a chronic Autoimmunity connective tissue disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body?s cells and tissue, resulting in inflammation and tissue damage....
 (SLE), a disease of the immune system
Immune system

An immune system is a collection of biological processes within an organism that protects against disease by identifying and killing pathogens and tumour cells....
. Apart from the kidneys, SLE can also damage the skin
Skin

The skin is the outer covering of the body, also known as the epidermis. It is the largest organ of the integumentary system made up of multiple layers of epithelial biological tissue, and guards the underlying muscles, bones, ligaments and organ s....
, joints, nervous system
Nervous system

The nervous system is a Neural network of specialized cells that communicate information about an animal's surroundings and itself. It processes this information and causes reactions in other parts of the body....
 and virtually any organ or system in the body.

Signs and symptoms

Sufferers of lupus nephritis may or may not have symptoms of kidney disease, but it can manifest itself through weight gain, high blood pressure
Hypertension

Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated....
, darker foamy urine
Urine

Urine is a liquid waste product of the body secreted by the kidneys by a process of filtration from blood called urination and excreted through the urethra....
 or swelling
Edema

File:Oedema.jpgEdema or Oedema , formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body....
 around the eyes, legs, ankles or fingers.

Histologically a wire-loop lesion will be present. The wire loop lesion is a glomerular capillary loop with subendothelial immune complex deposition that is circumferential around the loop.

Furthermore, patients may suffer from other symptoms of lupus unrelated to kidney function. Such symptoms can include arthritis
Arthritis

Arthritis is a group of conditions involving damage to the joints of the body. Arthritis is the leading cause of disability in people older than fifty-five years....
, fevers, gastro-intestinal disturbances, headaches, fatigue
Fatigue (physical)

Fatigue is a weariness caused by exertion. It can describe a range of afflictions, varying from a general state of wikt:lethargy to a specific work-induced burning sensation within one's muscles....
, and fluid in the joints.

Diagnosis

The diagnosis of lupus nephritis depends on blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
 tests, urinalysis
Urinalysis

File:Pyuria2.JPGA urinalysis is an array of tests performed on urine and one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes....
, X-rays, ultrasound
Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing . Although this limit varies from person to person, it is approximately 20 Hertz in healthy, young adults and thus, 20 kHz serves as a useful lower limit in describing ultrasound....
 scans of the kidneys, and a kidney biopsy
Biopsy

A biopsy is a medical test involving the removal of Cell_s or Biological tissues for examination. It is the removal of tissue from a living subject to determine the presence or extent of a disease....
.

The World Health Organization
World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health....
 has divided lupus nephritis into five classes based on the biopsy. This classification was defined in 1982 and revised in 1995.

  • Class I is minimal mesangial glomerulonephritis
    Minimal mesangial glomerulonephritis

    Minimal mesangial glomerulonephritis is a type of glomerulonephritis is seen in 10% to 25% of SLE cases, and is associated with mild clinical symptoms....
     which is histologically normal on light microscopy but with mesangial deposits on electron microscopy.
  • Class II is based on a finding of mesangial proliferative lupus nephritis. This form typically responds completely to treatment with corticosteroids.
  • Class III is focal proliferative nephritis
    Focal proliferative nephritis

    Focal proliferative nephritisis is a type of glomerulonephritis seen in 20% to 35% of cases of SLE, and, as the name suggests, lesions are visualized in only portions of fewer than half the glomeruli....
     and often successfully responds to treatment with high doses of corticosteroids.
  • Class IV is diffuse proliferative nephritis
    Diffuse proliferative nephritis

    Diffuse proliferative nephritis is a type of glomerulonephritis that is the most serious form of renal lesions in SLE and is also the most common, occurring in 35% to 60% of patients....
    . This form is mainly treated with corticosteroids and immunosuppressant drugs.
  • Class V is membranous nephritis and is characterized by extreme edema and protein loss.
  • Class VI Glomerulosclerosis
    Glomerulosclerosis

    Glomerulosclerosis refers to a hardening of the glomerulus in the kidney.More specifically, it can refer to:* focal segmental glomerulosclerosis...


Medicines that decrease swelling, lower blood pressure, and decrease inflammation by suppressing the immune system: Patients may need to monitor intake of protein, sodium, and potassium. Patients with severe disease should restrict their sodium intake to 2 grams per day and limit fluid as well. Depending on the histology, renal function and degree of proteinuria, patients may require steroid therapy or chemotherapy regimens such as cyclophosphamide, azathioprine, mycophenolate mofetil, or cyclosporine.

The medical therapy for lupus nephritis depends on the severity of the disease. For mild disease, corticosteroids are, in general, prescribed. More severe disease requires treatment with immunosuppressant agents. The two most commonly-used agents are mycophenolate mofetil and intravenous cyclophosphamide
Cyclophosphamide

Cyclophosphamide , also known as cytophosphane, is a nitrogen mustard alkylating antineoplastic agent, from the oxazophorines group. It is used to treat various types of cancer and some autoimmune disorders....
. One recent study compared these two drugs. The authors showed that patients with Class III or IV disease are more likely to benefit from mycophenolate mofetil as compared to cyclophosphamide
Cyclophosphamide

Cyclophosphamide , also known as cytophosphane, is a nitrogen mustard alkylating antineoplastic agent, from the oxazophorines group. It is used to treat various types of cancer and some autoimmune disorders....
. However, a larger study by the same authors that directly compared these therapies did not show that Mycophenolate was superiour to cyclophosphamide except in non-caucasian non-asian patients. In caucasian or asian patients both treatments worked equally well. There was no overall difference in safety in this trial, although cyclophosphamide may induce permanent infertility in young women, which is a significant drawback. As a result, mycophenolate mofetil is now considered to be an alternative therapy for this disease.

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