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| Name = Lupus nephritis | | | Name = Lupus nephritis | |
| Image = dpgn.jpg| | | Image = dpgn.jpg| |
| Caption = Type IV lupus nephritis: The classic "flea-bitten" appearance of the cortical surface in the diffuse proliferative glomerulonephritides. (Courtesy of Ed Uthman, MD)]]| | | Caption = <nowiki>Type IV lupus nephritis: The classic "flea-bitten" appearance of the cortical surface in the diffuse proliferative glomerulonephritides. (Courtesy of Ed Uthman, MD)]]</nowiki>| |
| DiseasesDB = |
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| ICD10 = {{ICD10|N|08|5|n|00}} |
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| ICD9 = {{ICD9|583.81}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000481 |
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| MeshID = D008181 |
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| }} | | }} |
| {{Search infobox}} | | {{Lupus nephritis}} |
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| '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}}; {{AE}}[[User:Okamal|Omer Kamal, M.D.]][mailto:okamal@bidmc.harvard.edu <nowiki>[2]</nowiki>] {{CZ}}; [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]; {{AIDA}}{{RT}}''' ''' |
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| '''Associate Editor-In-Chief:''' {{CZ}} [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]; {{RT}}
| | {{SK}} Nephritis - lupus; lupus glomerular disease |
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| ==Overview== | | == [[Lupus nephritis overview|Overview]] == |
| '''Lupus nephritis''' is an inflammation of the kidney caused by [[systemic lupus erythematosus]] (SLE), a disease of the [[immune system]]. Apart from the kidneys, SLE can also damage the [[skin]], joints, [[nervous system]] and virtually any organ or system in the body.
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| ==Classification== | | == [[Lupus nephritis historical perspective|Historical Perspective]] == |
| The World Health Organization has divided lupus nephritis into five classes based on the [[biopsy]].
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| *Class I is histologically normal and does not show any evidence of disease.
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| *Class II is based on a finding of mesangial lupus nephritis
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| *Class III is focal proliferative [[nephritis]]
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| *Class IV is diffuse proliferative nephritis
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| *Class V is membranous nephritis and is characterized by extreme edema and protein loss.
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| *Class VI Glomerulosclerosis
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| ==Pathophysiology== | | == [[Lupus nephritis classification|Classification]] == |
| Systemic lupus erythematosus (SLE, or lupus) is an [[autoimmune]] disease. This means there is a problem with the body's immune system.
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| Normally, the immune system helps protect the body from harmful substances. But in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. As a result, the immune system attacks otherwise healthy cells and tissue.
| | == [[Lupus nephritis pathophysiology|Pathophysiology]] == |
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| ==Differentiating from other Diseases== | | == [[Lupus nephritis causes|Causes]] == |
| Diseases with similar symptoms are
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| * [[Chronic glomerulonephritis]]
| | == [[Differentiating lupus nephritis from other diseases|Differentiating Lupus nephritis from other Diseases]] == |
| * [[Polyarteritis nodosa]]
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| * [[Wegener granulomatosis ]]
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| ==Natural History, Complications and Prognosis== | | == [[Lupus nephritis epidemiology and demographics|Epidemiology and Demographics]] == |
| ===Natural History===
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| [[Lupus nephritis]] may damage different parts of the kidney. Class I has normal histology and does not show any evidence of disease and class V shows an extensive disease. | |
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| ===Complications=== | | == [[Lupus nephritis risk factors|Risk Factors]] == |
| Possible complications include:
| | ==[[Lupus nephritis screening|Screening]]== |
| * Interstitial nephritis
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| * [[Nephrotic syndrome]]
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| * [[Membranous glomerulonephritis]]
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| * [[Kidney failure]] - acute and chronic
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| * [[End steg renal disease]]
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| ===Prognosis=== | | == [[Lupus nephritis natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
| * Prognosis depends on the specific form of lupus nephritis. Patients may have flare-ups in between symptom free intervals.
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| * Although lupus nephritis may return in a transplanted kidney, it rarely leads to [[end-stage kidney disease]].
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| ==Diagnosis== | | == Diagnosis == |
| ===Symptoms===
| | [[Diagnostic criteria]] | [[Lupus nephritis history and symptoms|History and Symptoms]] | [[Lupus nephritis physical examination|Physical Examination]] | [[Lupus nephritis laboratory findings|Laboratory Findings]] | [[Lupus nephritis chest x ray|Chest X Ray]] | [[Lupus nephritis CT|CT]] | [[Lupus nephritis MRI|MRI]] | [[Lupus nephritis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Lupus nephritis other imaging findings|Other Imaging Findings]] | [[Lupus nephritis other diagnostic studies|Other Diagnostic Studies]] |
| Sufferers of lupus nephritis may or may not have symptoms of [[kidney disease]], but it can manifest itself through:
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| * [[Weight gain]]
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| * Darker foamy [[urine]]
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| * [[Edema|swelling]] around the eyes, legs, ankles or fingers.
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| Furthermore, patients may suffer from other symptoms of lupus unrelated to kidney function. Such symptoms can include
| | == Treatment == |
| * [[Arthritis]] - joint pains
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| * [[Fevers]]
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| * Gastro-intenstinal disturbances
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| * [[Headaches]]
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| * [[Fatigue (physical)|Fatigue]]
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| * Swollen joints
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| ===Physical Examination===
| | [[Lupus nephritis medical therapy|Medical Therapy]] | [[Lupus nephritis surgery|Surgery]] | [[Lupus nephritis primary prevention|Primary Prevention]] | [[Lupus nephritis secondary prevention|Secondary Prevention]] | [[Lupus nephritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Lupus nephritis future or investigational therapies|Future or Investigational Therapies]] |
| ====Vitals====
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| * [[Elevated body temperature]]
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| * [[Hypertension|high blood pressure]]
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| ====Eyes==== | | ==Case Studies== |
| * Peri-orbital puffiness can be noticed in patients with advanced disease having [[renal failure]].
| | [[Lupus nephritis case study one|Case #1]] |
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| ====Extremities====
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| * [[Edema|Swelling]] around the legs, ankles or fingers.
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| * Swollen joints
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| ===Laboratory Findings===
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| Tests that may be done include:
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| * [[ANA]] titer.
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| * [[BUN]] and [[creatinine]].
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| * [[Lupus test]].
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| * [[Urinalysis]].
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| * Urine [[immunoglobulin light chain]]
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| ====Chest X-ray====
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| * Shows signs of fluid collection in the lungs in very severe cases.
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| ====Ultrasound====
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| * [[Ultrasound]] scans of the kidneys
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| ====Biopsy====
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| * A kidney biopsy is not used to diagnose lupus nephritis, but to determine what treatment is appropriate.
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| * Severity of the disease can be assessed based on the histology of the biopsy specimen.
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| ==Treatment==
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| ===Medical Therapy===
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| * Medicines which decrease swelling, lower blood pressure and decrease inflammation by suppressing the immune system.
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| * Patients may need to monitor intake of protein, sodium, and potassium.
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| * Patients with severe disease should restrict their sodium intake to 2 grams per day and limit fluid as well.
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| * 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]].
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| * [[Dialysis]] to control symtopms of [[kidney failure]].
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| The drug therapy for lupus nephritis depends on the severity of the disease.
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| * For mild disease, corticosteroids are generally prescribed. More severe disease requires treatment with immunosuppressant agents. The two most commonly used agents are [[mycophenolate mofetil]] and intravenous [[cyclophosphamide]]. One recent study compared these two drugs.<ref name="Ginzler">Ginzler EM, Dooley MA, Aranow C, Kim MY, et al. "Mycophenolate Mofetil or Intravenous Cyclophosphamide for Lupus Nephritis." New England Journal of Medicine. 353:21. 2219-2229. 24 November 2005.</ref>
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| * The authors showed that patients with Class III or IV disease are more likely to benefit from [[mycophenolate mofetil]] as compared to [[cyclophosphamide]]. As a result, mycophenolate mofetil is now considered to be the first-line therapy for this disease.
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| ===Surgical Therapy===
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| * A kidney [[transplant]] may be recommended. People with active lupus should not have a transplant because the condition can occur in the transplanted kidney.
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| ==References==
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| {{Reflist|2}}
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| ==External links==
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| *[http://www.lupusclinicalstudy.com/ Lupus Nephritis Clinical Research Study]
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| *[http://www.londonlupuscentre.co.uk/ London Lupus Centre - Treatment, Diagnosis, Research]
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| *[http://www.lupus.org/ Lupus Foundation of America, Inc.]
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| *[http://www.lupusresearchinstitute.org/ Lupus Research Institute]
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| *[http://www.lupusny.org/ S.L.E. Lupus Foundation]
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| *[http://www.lupusinternational.com/ Lupus International]
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| {{Nephrology}} | | {{Nephrology}} |
