Lupus nephritis diagnostic study of choice: Difference between revisions

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Revision as of 14:55, 20 July 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The page name should be "[Disease name] diagnostic study of choice", with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
Goal:
- To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
- To describe the gold standard test for the diagnosis of [disease name].
- To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
As with all microchapter pages linking to the main page, at the top of the edit box put {{CMG}}, your name template, and the microchapter navigation template you created at the beginning.
Remember to create links within WikiDoc by placing [[square brackets]] around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example, if a sentence contained the phrase anterior spinal artery syndrome, the link should be to anterior spinal artery syndrome not anterior or artery or syndrome. For more information on how to create links, click here.
Remember to follow the same format and capitalization of letters as outlined in the template below.
You should include the name of the disease in the first sentence of every subsection.

Diagnostic criteria

In 2012, Systemic Lupus International Collaboration Criteria (SLICC) developed a new criteria for SLE diagnosis. SLICC criteria for the classification of systemic lupus erythematosus was developed based on the old ACR criteria for the classification of systemic lupus erythematosus to address a more sensitive diagnostic criteria and also to cover weaknesses of the previous ACR criteria.^[1]^[2]

Based on SLICC criteria, diagnosis of SLE is defined as:^[3]

Meeting at least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six immunologic criteria

OR

Biopsy-proven nephritis compatible with SLE in the presence of antinuclear antibodies (ANA) or anti-double-stranded DNA (dsDNA) antibodies

A criterion is considered positive if one or more of the observations listed in the definition for the criterion are present in the patient. A criterion should only be counted once, regardless of the number of observations in the definition that the patient presents with.

Category	Criterion	Definition
Clinical	Acute cutaneous lupus	Lupus malar rash Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds Bullous lupus Toxic epidermal necrolysis variant of SLE Maculopapular lupus rash Photosensitive lupus rash (in the absence of dermatomyositis); Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation Subacute cutaneous lupus Nonindurated psoriaform and/or annular polycyclic lesions that resolve without scarring, although occasionally with postinflammatory dyspigmentation or telangiectasias
	Chronic cutaneous lupus	Classic discoid rash Localized (above the neck) Generalized (above and below the neck) Hypertrophic (verrucous) lupus Lupus panniculitis (profundus) Mucosal lupus Lupus erythematosus tumidus Chilblains lupus OR Discoid lupus/lichen planus overlap
	Nonscarring alopecia	Diffuse thinning or hair fragility with visible broken hairs (in the absence of other causes, such as alopecia areata, drugs, iron deficiency, and androgenic alopecia)
	Oral or nasal ulcers	Palate, buccal, tongue, or nasal ulcers (in the absence of other causes, such as vasculitis, Behçet's disease, infection, inflammatory bowel disease, reactive arthritis, and acidic foods)
	Joint disease	Synovitis involving two or more joints, characterized by swelling or effusion Tenderness in two or more joints and at least 30 minutes of morning stiffness
	Serositis	Typical pleurisy for more than one day, pleural effusions, or pleural rub Typical pericardial pain (pain with recumbency improved by sitting forward) for more than one day, pericardial effusion, pericardial rub, or pericarditis by electrocardiography in the absence of other causes, such as infection, uremia, and Dressler's syndrome
	Renal	Urine protein-to-creatinine ratio (or 24-hour urine protein) representing 500 mg protein/24 hours Red blood cell casts
	Neurologic	Seizures Psychosis Mononeuritis multiplex (in the absence of other known causes, such as primary vasculitis) Myelitis Peripheral or cranial neuropathy (in the absence of other known causes, such as primary vasculitis, infection, and diabetes mellitus) Acute confusional state (in the absence of other causes, including toxic/metabolic, uremia, drugs)
Hematologic	Hemolytic anemia	Hemoglobin less than 12 g/dL in females and 13 g/dL in males
	Leukopenia or lymphopenia	Leukopenia (<4000/mm3 at least once) (in the absence of other known causes, such as Felty's syndrome, drugs, and portal hypertension) Lymphopenia (<1000/mm3 at least once) (in the absence of other known causes, such as glucocorticoids, drugs, and infection)
	Thrombocytopenia	Thrombocytopenia (<100,000/mm3) at least once in the absence of other known causes, such as drugs, portal hypertension, and thrombotic thrombocytopenic purpura
Immunologic	ANA	ANA level above laboratory reference range
	Anti-dsDNA	Anti-dsDNA antibody level above laboratory reference range (or >twofold the reference range if tested by ELISA)
	Anit-SM	Presence of antibody to Sm nuclear antigen
	Antiphospholipid	Antiphospholipid antibody positivity as determined by any of the following: Positive test result for lupus anticoagulant False-positive test result for rapid plasma reagin Medium- or high-titer anticardiolipin antibody level (IgA, IgG, or IgM) Positive test result for anti-beta 2-glycoprotein I (IgA, IgG, or IgM)
	Low complement	Low C3 Low C4 Low CH50
	Direct Coombs' test	Direct Coombs' test in the absence of hemolytic anemia

References

↑ Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ (1982). "The 1982 revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 25 (11): 1271–7. PMID 7138600.
↑ Hochberg MC (1997). "Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 40 (9): 1725. doi:10.1002/1529-0131(199709)40:9<1725::AID-ART29>3.0.CO;2-Y. PMID 9324032.
↑ Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, Bruce IN, Isenberg D, Wallace DJ, Nived O, Sturfelt G, Ramsey-Goldman R, Bae SC, Hanly JG, Sánchez-Guerrero J, Clarke A, Aranow C, Manzi S, Urowitz M, Gladman D, Kalunian K, Costner M, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG, Sigler L, Hameed S, Fang H, Pham N, Brey R, Weisman MH, McGwin G, Magder LS (2012). "Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus". Arthritis Rheum. 64 (8): 2677–86. doi:10.1002/art.34473. PMC 3409311. PMID 22553077.

Template:WH Template:WS

[pmid7138600-1] Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ (1982). "The 1982 revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 25 (11): 1271–7. PMID 7138600.

[pmid9324032-2] Hochberg MC (1997). "Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 40 (9): 1725. doi:10.1002/1529-0131(199709)40:9<1725::AID-ART29>3.0.CO;2-Y. PMID 9324032.

[pmid22553077-3] Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, Bruce IN, Isenberg D, Wallace DJ, Nived O, Sturfelt G, Ramsey-Goldman R, Bae SC, Hanly JG, Sánchez-Guerrero J, Clarke A, Aranow C, Manzi S, Urowitz M, Gladman D, Kalunian K, Costner M, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG, Sigler L, Hameed S, Fang H, Pham N, Brey R, Weisman MH, McGwin G, Magder LS (2012). "Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus". Arthritis Rheum. 64 (8): 2677–86. doi:10.1002/art.34473. PMC 3409311. PMID 22553077.

[1]

[2]

[3]

@@ Line 13: / Line 13: @@
 * You should include the name of the disease in the first sentence of every subsection.
-== Diagnostic Study of Choice ==
+==Diagnostic criteria==
+In 2012, Systemic Lupus International Collaboration Criteria (SLICC) developed a new criteria for SLE diagnosis. SLICC criteria for the classification of [[systemic lupus erythematosus]] was developed based on the old ACR criteria for the classification of [[systemic lupus erythematosus]] to address a more sensitive diagnostic criteria and also to cover weaknesses of the previous ACR criteria.<ref name="pmid7138600">{{cite journal |vauthors=Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ |title=The 1982 revised criteria for the classification of systemic lupus erythematosus |journal=Arthritis Rheum. |volume=25 |issue=11 |pages=1271–7 |year=1982 |pmid=7138600 |doi= |url=}}</ref><ref name="pmid9324032">{{cite journal |vauthors=Hochberg MC |title=Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus |journal=Arthritis Rheum. |volume=40 |issue=9 |pages=1725 |year=1997 |pmid=9324032 |doi=10.1002/1529-0131(199709)40:9&lt;1725::AID-ART29&gt;3.0.CO;2-Y |url=}}</ref>
-===== Template statements =====
+Based on SLICC criteria, diagnosis of SLE is defined as:<ref name="pmid22553077">{{cite journal |vauthors=Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, Bruce IN, Isenberg D, Wallace DJ, Nived O, Sturfelt G, Ramsey-Goldman R, Bae SC, Hanly JG, Sánchez-Guerrero J, Clarke A, Aranow C, Manzi S, Urowitz M, Gladman D, Kalunian K, Costner M, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG, Sigler L, Hameed S, Fang H, Pham N, Brey R, Weisman MH, McGwin G, Magder LS |title=Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus |journal=Arthritis Rheum. |volume=64 |issue=8 |pages=2677–86 |year=2012 |pmid=22553077 |pmc=3409311 |doi=10.1002/art.34473 |url=}}</ref>
+* Meeting at least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six [[Immunological|immunologic]] criteria
+'''OR'''
+* Biopsy-proven [[nephritis]] compatible with [[SLE]] in the presence of [[Antinuclear antibodies|antinuclear antibodies (ANA)]] or [[Double stranded DNA antibody|anti-double-stranded DNA]] (dsDNA) [[antibodies]]
+'''A criterion is considered positive if one or more of the observations listed in the definition for the criterion are present in the patient. A criterion should only be counted once, regardless of the number of observations in the definition that the patient presents with.'''
+{| class="wikitable"
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Category
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Criterion
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Definition
+|-
+| rowspan="8" |<small>Clinical</small>
+! style="background: #DCDCDC; " | Acute cutaneous lupus
+|
+* Lupus [[malar rash]]
+** Fixed [[erythema]], flat or raised, over the [[malar]] eminences, tending to spare the [[nasolabial folds]]
+* [[Bullous]] lupus
+* [[Toxic epidermal necrolysis]] variant of SLE
+* [[Maculopapular rash|Maculopapular]] lupus [[rash]]
+* [[Photosensitive]] lupus [[rash]] (in the absence of [[dermatomyositis]]);
+** Skin [[rash]] as a result of unusual reaction to sunlight, by patient history or physician observation
-=== Gold standard/Study of choice: ===
+* Subacute cutaneous lupus
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+** Nonindurated psoriaform and/or annular polycyclic [[lesions]] that resolve without [[scarring]], although occasionally with [[Postinflammatory hypopigmentation|postinflammatory dyspigmentation]] or [[Telangiectasia|telangiectasias]]
-* The following result of [gold standard test] is confirmatory of [disease name]:
+|-
-** Result 1
+! style="background: #DCDCDC; " |Chronic cutaneous lupus
-** Result 2
+|
-* The [name of the investigation] should be performed when:
+* Classic [[Discoid lupus|discoid rash]]
-** The patient presented with symptoms/signs 1. 2, 3.
+** Localized (above the neck)
-** A positive [test] is detected in the patient.
+** Generalized (above and below the neck)
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+** [[Hypertrophic]] (verrucous) lupus
-* The diagnostic study of choice for [disease name] is [name of the investigation].
+** Lupus [[panniculitis]] (profundus)
-* There is no single diagnostic study of choice for the diagnosis of [disease name].
+** [[Mucosal]] lupus
-* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
+** [[Lupus erythematosus]] tumidus
-* [Disease name] is mainly diagnosed based on clinical presentation.
+** Chilblains lupus OR
-* Investigations:
+** Discoid lupus[[Lichen planus|/lichen planus]] overlap
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
+|-
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
+! style="background: #DCDCDC; " |Nonscarring [[alopecia]]
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
+|
+* Diffuse thinning or hair fragility with visible broken hairs (in the absence of other causes, such as [[alopecia areata]], drugs, [[iron deficiency]], and [[androgenic alopecia]])
+|-
+! style="background: #DCDCDC; " |[[Oral ulcer|Oral]] or nasal ulcers
+|
+* [[Palate]], [[buccal]], [[tongue]], or nasal [[ulcers]] (in the absence of other causes, such as [[vasculitis]], [[Behçet's disease]], [[infection]], [[inflammatory bowel disease]], [[reactive arthritis]], and acidic foods)
+|-
+! style="background: #DCDCDC; " |[[Arthralgia|Joint disease]]
+|
+* [[Synovitis]] involving two or more [[joints]], characterized by [[swelling]] or effusion
+* [[Tenderness]] in two or more [[joints]] and at least 30 minutes of morning stiffness
+|-
+! style="background: #DCDCDC; " |[[Serositis]]
+|
+* Typical [[pleurisy]] for more than one day, [[Pleural effusion|pleural effusions]], or [[pleural]] rub
+* Typical pericardial pain (pain with recumbency improved by sitting forward) for more than one day, [[pericardial effusion]], pericardial rub, or [[pericarditis]] by [[electrocardiography]] in the absence of other causes, such as [[infection]], [[uremia]], and [[Dressler's syndrome]]
+|-
+! style="background: #DCDCDC; " |[[Renal]]
+|
+* Urine protein-to-[[creatinine]] ratio (or 24-hour urine protein) representing 500 mg protein/24 hours
+* [[Red blood cell]] casts
+|-
+! style="background: #DCDCDC; " |[[Neurological|Neurologic]]
+|
+* [[Seizure|Seizures]]
+* [[Psychosis]]
+* [[Mononeuritis multiplex]] (in the absence of other known causes, such as primary [[vasculitis]])
+* [[Myelitis]]
+* [[Peripheral neuropathy|Peripheral]] or [[Neuropathy|cranial neuropathy]] (in the absence of other known causes, such as primary [[vasculitis]], [[infection]], and [[diabetes mellitus]])
+* [[Confusion|Acute confusional state]] (in the absence of other causes, including toxic/metabolic, [[uremia]], drugs)
+|-
+| rowspan="3" |<small>[[Hematologic]]</small>
+! style="background: #DCDCDC; " |[[Hemolytic anemia]]
+|
+* [[Hemoglobin]] less than 12 g/dL in females and 13 g/dL in males
+|-
+! style="background: #DCDCDC; " |[[Leukopenia]] or [[lymphopenia]]
+|
+* [[Leukopenia]] (<4000/mm3 at least once) (in the absence of other known causes, such as [[Felty's syndrome]], [[drugs]], and [[portal hypertension]])
-==== The comparison table for diagnostic studies of choice for [disease name] ====
+* [[Lymphopenia]] (<1000/mm3 at least once) (in the absence of other known causes, such as [[glucocorticoids]], [[drugs]], and [[infection]])
-{|
+|-
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! style="background: #DCDCDC; " |[[Thrombocytopenia]]
-! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
+|
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
+* [[Thrombocytopenia]] (<100,000/mm3) at least once in the absence of other known causes, such as [[drugs]], [[portal hypertension]], and [[thrombotic thrombocytopenic purpura]]
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
+|-
+| rowspan="6" |<small>[[Immunological|Immunologic]]</small>
+! style="background: #DCDCDC; " |[[ANA]]
+|
+* [[ANA]] level above laboratory reference range
+|-
+! style="background: #DCDCDC; " |[[Anti-dsDNA antibody|Anti-dsDNA]]
+|
+* [[Anti-dsDNA antibody]] level above laboratory reference range (or >twofold the reference range if tested by [[Enzyme linked immunosorbent assay (ELISA)|ELISA]])
+|-
+! style="background: #DCDCDC; " |Anit-SM
+|
+* Presence of [[antibody]] to [[Smith antigen|Sm nuclear antigen]]
+|-
+! style="background: #DCDCDC; " |[[Antiphospholipid antibody|Antiphospholipid]]
+|
+* [[Antiphospholipid antibodies|Antiphospholipid antibody]] positivity as determined by any of the following:
+** Positive test result for [[lupus anticoagulant]]
+** False-positive test result for [[rapid plasma reagin]]
+** Medium- or high-titer [[anticardiolipin antibody]] level ([[IgA]], [[IgG]], or [[IgM]])
+** Positive test result for anti-beta 2-glycoprotein I ([[IgA]], [[IgG]], or [[IgM]])
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
+! style="background: #DCDCDC; " |Low [[complement]]
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
+|
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+* Low [[C3 glomerular disease|C3]]
+* Low [[C4 disease|C4]]
+* Low CH50
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
+! style="background: #DCDCDC; " |[[Coombs' Test|Direct Coombs' test]]
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+|
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
+* [[Coombs' Test|Direct Coombs' test]] in the absence of [[hemolytic anemia]]
 |}
-<small> ✔= The best test based on the feature </small>
-===== Diagnostic results =====
-The following result of [investigation name] is confirmatory of [disease name]:
-* Result 1
-* Result 2
-===== Sequence of Diagnostic Studies =====
-The [name of investigation] should be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-=== Diagnostic Criteria ===
-* Here you should describe the details of the diagnostic criteria.
-*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
-*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
-*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
-*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
-*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
-*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
-*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
-* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-** Criteria 1
-** Criteria 2
-** Criteria 3
-IF there are clear, established diagnostic criteria:
-*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-IF there are no established diagnostic criteria:
-*There are no established criteria for the diagnosis of [disease name].
 ==References==

Lupus nephritis diagnostic study of choice: Difference between revisions

Revision as of 14:55, 20 July 2018

Overview

Diagnostic criteria

References

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