Lupus nephritis natural history, complications and prognosis
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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]
- The symptoms of Lupus nephritis typically develop within three years after having SLE.[2]
- If left untreated, thirty percent of patients with SLE may progress to develop hematuria, nephrotic syndrome, and hypertension.
Complications
Possible complications include:
- Interstitial nephritis
- Nephrotic syndrome
- Membranous glomerulonephritis
- 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.
- Nephrotic syndrome carries worse prognosis.
- Creatinine level: Patients with elevated creatinine (>3 mg/dL) at presentation have worse 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.
- Young age onset carries worse prognosis.
- Male gender have poorer outcomes than female.
- Black race have worse outcomes than other races.
- Although lupus nephritis may return in a transplanted kidney, it rarely leads to end-stage kidney disease.
- 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.
- ↑ 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.