Lupus nephritis natural history, complications and prognosis: Difference between revisions
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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. | [[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. | ||
*The symptoms of [[Lupus nephritis]] usually develop in one half of the patients with [[SLE]] and start with symptoms such as [[proteinuria]].<ref name="pmid8479324">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Doménech I, Aydintug AO, Jedryka-Góral A, de Ramón E |title=Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus |journal=Medicine (Baltimore) |volume=72 |issue=2 |pages=113–24 |date=March 1993 |pmid=8479324 |doi= |url=}}</ref><ref name="pmid12079714">{{cite journal |vauthors=Seligman VA, Lum RF, Olson JL, Li H, Criswell LA |title=Demographic differences in the development of lupus nephritis: a retrospective analysis |journal=Am. J. Med. |volume=112 |issue=9 |pages=726–9 |date=June 2002 |pmid=12079714 |doi= |url=}}</ref><ref name="pmid145307792">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR |title=Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients |journal=Medicine (Baltimore) |volume=82 |issue=5 |pages=299–308 |date=September 2003 |pmid=14530779 |doi=10.1097/01.md.0000091181.93122.55 |url=}}</ref> | *The symptoms of [[Lupus nephritis]] usually develop in one half of the patients with [[SLE]] and start with symptoms such as [[proteinuria]].<ref name="pmid8479324">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Doménech I, Aydintug AO, Jedryka-Góral A, de Ramón E |title=Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus |journal=Medicine (Baltimore) |volume=72 |issue=2 |pages=113–24 |date=March 1993 |pmid=8479324 |doi= |url=}}</ref><ref name="pmid12079714">{{cite journal |vauthors=Seligman VA, Lum RF, Olson JL, Li H, Criswell LA |title=Demographic differences in the development of lupus nephritis: a retrospective analysis |journal=Am. J. Med. |volume=112 |issue=9 |pages=726–9 |date=June 2002 |pmid=12079714 |doi= |url=}}</ref><ref name="pmid145307792">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR |title=Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients |journal=Medicine (Baltimore) |volume=82 |issue=5 |pages=299–308 |date=September 2003 |pmid=14530779 |doi=10.1097/01.md.0000091181.93122.55 |url=}}</ref> | ||
*The symptoms of [[Lupus nephritis]] typically develop within three years after having [[SLE]].<ref name="pmid145307792" /><ref name="pmid27821390">{{cite journal |vauthors=Almaani S, Meara A, Rovin BH |title=Update on Lupus Nephritis |journal=Clin J Am Soc Nephrol |volume=12 |issue=5 |pages=825–835 |date=May 2017 |pmid=27821390 |pmc=5477208 |doi=10.2215/CJN.05780616 |url=}}</ref> | *The symptoms of [[Lupus nephritis]] typically develop within three years after having [[SLE]].<ref name="pmid145307792" /><ref name="pmid27821390">{{cite journal |vauthors=Almaani S, Meara A, Rovin BH |title=Update on Lupus Nephritis |journal=Clin J Am Soc Nephrol |volume=12 |issue=5 |pages=825–835 |date=May 2017 |pmid=27821390 |pmc=5477208 |doi=10.2215/CJN.05780616 |url=}}</ref><ref name="pmid21794772">{{cite journal |vauthors=Alarcón GS |title=Multiethnic lupus cohorts: what have they taught us? |journal=Reumatol Clin |volume=7 |issue=1 |pages=3–6 |date=2011 |pmid=21794772 |doi=10.1016/j.reuma.2010.11.001 |url=}}</ref> | ||
*If left untreated, thirty percent of patients with [[SLE]] may progress to develop [[hematuria]], [[nephrotic syndrome]], and [[hypertension]]. | *If left untreated, thirty percent of patients with [[SLE]] may progress to develop [[hematuria]], [[nephrotic syndrome]], and [[hypertension]]. | ||
| Line 16: | Line 16: | ||
* Interstitial nephritis | * Interstitial nephritis | ||
* [[Nephrotic syndrome]] | * [[Nephrotic syndrome]] | ||
* [[Membranous glomerulonephritis]] | * [[Membranous glomerulonephritis]]<ref name="pmid21794772" /> | ||
* [[Kidney failure]] - acute and chronic | * [[Kidney failure]] - acute and chronic | ||
* [[End stage renal disease]] | * [[End stage renal disease]] | ||
| Line 23: | Line 23: | ||
===Prognosis=== | ===Prognosis=== | ||
* The class of lupus nephritis: [[Focal lupus nephritis]], [[minimal mesangial lupus nephritis]] and [[mesangial proliferative lupus nephritis]] have better prognosis than other classes. And, [[advanced sclerosis lupus nephritis]] carries a poor prognosis.<ref name="pmid278213902">{{cite journal |vauthors=Almaani S, Meara A, Rovin BH |title=Update on Lupus Nephritis |journal=Clin J Am Soc Nephrol |volume=12 |issue=5 |pages=825–835 |date=May 2017 |pmid=27821390 |pmc=5477208 |doi=10.2215/CJN.05780616 |url=}}</ref> | * The class of lupus nephritis: [[Focal lupus nephritis]], [[minimal mesangial lupus nephritis]] and [[mesangial proliferative lupus nephritis]] have better prognosis than other classes. And, [[advanced sclerosis lupus nephritis]] carries a poor prognosis.<ref name="pmid278213902">{{cite journal |vauthors=Almaani S, Meara A, Rovin BH |title=Update on Lupus Nephritis |journal=Clin J Am Soc Nephrol |volume=12 |issue=5 |pages=825–835 |date=May 2017 |pmid=27821390 |pmc=5477208 |doi=10.2215/CJN.05780616 |url=}}</ref> | ||
* Nephrotic syndrome carries worse prognosis. | * Nephrotic syndrome carries worse prognosis.<ref name="pmid21794772" /> | ||
* Creatinine level: Patients with elevated [[creatinine]] (>3 mg/dL) at presentation have worse outcomes. | * Creatinine level: Patients with elevated [[creatinine]] (>3 mg/dL) at presentation have worse outcomes.<ref name="pmid21794772" /> | ||
* Patients with persistently elevated [[anti-dsDNA]] and low C3 and C4 levels have poorer outcomes. | * Patients with persistently elevated [[anti-dsDNA]] and low C3 and C4 levels have poorer outcomes. | ||
* Renal [[biopsy]] findings showing diffuse lupus nephritis or high chronicity index suggest worse prognosis.<ref name="pmid20089610">{{cite journal |vauthors=Ortega LM, Schultz DR, Lenz O, Pardo V, Contreras GN |title=Review: Lupus nephritis: pathologic features, epidemiology and a guide to therapeutic decisions |journal=Lupus |volume=19 |issue=5 |pages=557–74 |date=April 2010 |pmid=20089610 |doi=10.1177/0961203309358187 |url=}}</ref> | * Renal [[biopsy]] findings showing diffuse lupus nephritis or high chronicity index suggest worse prognosis.<ref name="pmid21794772" /><ref name="pmid20089610">{{cite journal |vauthors=Ortega LM, Schultz DR, Lenz O, Pardo V, Contreras GN |title=Review: Lupus nephritis: pathologic features, epidemiology and a guide to therapeutic decisions |journal=Lupus |volume=19 |issue=5 |pages=557–74 |date=April 2010 |pmid=20089610 |doi=10.1177/0961203309358187 |url=}}</ref> | ||
* Young age onset carries worse prognosis. | * Young age onset carries worse prognosis. | ||
* Male gender have poorer outcomes than female.<ref name="pmid20089610" /> | * Male gender have poorer outcomes than female.<ref name="pmid20089610" /> | ||
* Black race have worse outcomes than other races.<ref name="pmid20089610" /> | * Black race have worse outcomes than other races.<ref name="pmid20089610" /> | ||
* Although lupus nephritis may return in a transplanted kidney, it rarely leads to [[end-stage kidney disease]]. | * Although lupus nephritis may return in a transplanted kidney, it rarely leads to [[end-stage kidney disease]].<ref name="pmid21794772" /> | ||
*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%. | *Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[[2]] Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S. [3]
Overview
Common complications of Lupus nephritis include microscopic hematuria, nephrotic syndrome, celluar casts, elevated creatnine and destruction of more than 50% of glomeruli.
Natural History, Complications, and Prognosis
Natural History
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.
- The symptoms of Lupus nephritis usually develop in one half of the patients with SLE and start with symptoms such as proteinuria.[1][2][3]
- The symptoms of Lupus nephritis typically develop within three years after having SLE.[3][4][5]
- If left untreated, thirty percent of patients with SLE may progress to develop hematuria, nephrotic syndrome, and hypertension.
Complications
Possible complications include:[3]
- Interstitial nephritis
- Nephrotic syndrome
- Membranous glomerulonephritis[5]
- Kidney failure - acute and chronic
- End stage renal disease
- Hypertension
Prognosis
- The class of lupus nephritis: Focal lupus nephritis, minimal mesangial lupus nephritis and mesangial proliferative lupus nephritis have better prognosis than other classes. And, advanced sclerosis lupus nephritis carries a poor prognosis.[6]
- Nephrotic syndrome carries worse prognosis.[5]
- Creatinine level: Patients with elevated creatinine (>3 mg/dL) at presentation have worse outcomes.[5]
- Patients with persistently elevated anti-dsDNA and low C3 and C4 levels have poorer outcomes.
- Renal biopsy findings showing diffuse lupus nephritis or high chronicity index suggest worse prognosis.[5][7]
- Young age onset carries worse prognosis.
- Male gender have poorer outcomes than female.[7]
- Black race have worse outcomes than other races.[7]
- Although lupus nephritis may return in a transplanted kidney, it rarely leads to end-stage kidney disease.[5]
- Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
- Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
- The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
- [Subtype of disease/malignancy] is associated with the most favorable prognosis.
- The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
References
- ↑ Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Doménech I, Aydintug AO, Jedryka-Góral A, de Ramón E (March 1993). "Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus". Medicine (Baltimore). 72 (2): 113–24. PMID 8479324.
- ↑ Seligman VA, Lum RF, Olson JL, Li H, Criswell LA (June 2002). "Demographic differences in the development of lupus nephritis: a retrospective analysis". Am. J. Med. 112 (9): 726–9. PMID 12079714.
- ↑ 3.0 3.1 3.2 Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (September 2003). "Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients". Medicine (Baltimore). 82 (5): 299–308. doi:10.1097/01.md.0000091181.93122.55. PMID 14530779.
- ↑ Almaani S, Meara A, Rovin BH (May 2017). "Update on Lupus Nephritis". Clin J Am Soc Nephrol. 12 (5): 825–835. doi:10.2215/CJN.05780616. PMC 5477208. PMID 27821390.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Alarcón GS (2011). "Multiethnic lupus cohorts: what have they taught us?". Reumatol Clin. 7 (1): 3–6. doi:10.1016/j.reuma.2010.11.001. PMID 21794772.
- ↑ Almaani S, Meara A, Rovin BH (May 2017). "Update on Lupus Nephritis". Clin J Am Soc Nephrol. 12 (5): 825–835. doi:10.2215/CJN.05780616. PMC 5477208. PMID 27821390.
- ↑ 7.0 7.1 7.2 Ortega LM, Schultz DR, Lenz O, Pardo V, Contreras GN (April 2010). "Review: Lupus nephritis: pathologic features, epidemiology and a guide to therapeutic decisions". Lupus. 19 (5): 557–74. doi:10.1177/0961203309358187. PMID 20089610.