“Systemic Lupus Erythematosus” Renal features Iraj Salehi-Abari “Systemic Lupus Erythematosus” Renal features Iraj Salehi-Abari MD., Internist Rheumatologist salehiabari@sina.tums.ac.ir SLE

Definition: Chronic disease Systemic/Multi-organ disease Iraj Salehi-Abari Definition: Chronic disease Systemic/Multi-organ disease Inflammatory/Autoimmune disease Autoantibody/Immune Complex Skin, Joints, Kidneys, Lungs, Nervous system, Serous membranes,… y SLE

Renal involvement: Clinical (U/A + Cr): 50-75% Pathological: 100% Iraj Salehi-Abari Renal involvement: Clinical (U/A + Cr): 50-75% Pathological: 100% Increased frequency and severity in Blacks and Asians than it is in Whites Urinalysis/Urinary sediment, Urine protein (24 hr or spot), serum Cr, GFR and Renal biopsy SLE

Renal features: Asymptomatic (silent) Iraj Salehi-Abari Renal features: Asymptomatic (silent) Proteinuria: nephrotic, non-nephrotic range Hematuria/Pyuria/Urinary cast Azotemia/Uremia + Hypertension Elevated anti-dsDNA + low C3/C4/CH50 CKD/ End stage renal disease SLE

ISN* Classification of Lupus Nephritis: Iraj Salehi-Abari ISN* Classification of Lupus Nephritis: Class I: Minimal mesangial lupus nephritis Class II: Mesangial proliferative lupus nephritis Class III: Focal lupus nephritis Class IV: Diffuse lupus nephritis Class V: Membranous lupus nephritis Class VI: Advanced sclerosing lupus nephritis *International Society of Nephrology SLE

Clinical pictures of Lupus Nephritis: Iraj Salehi-Abari Clinical pictures of Lupus Nephritis: Class I: Normal U/A, normal serum Cr Class II: Microscopic hematuria&/or proteinuria, HTN? Class III: Hematuria/proteinuria in almost all cases but Nephrotic syndrome, elevated serum Cr and HTN in some cases SLE

Clinical pictures of Lupus Nephritis: Iraj Salehi-Abari Clinical pictures of Lupus Nephritis: Class IV: Hematuria/proteinuria in all cases and Nephrotic syndrome, elevated serum Cr and HTN in many cases Class V: Nephrotic syndrome: most often seen, hematuria and HTN: may be seen Class VI: Slowly progressive renal dysfunction  ESRD SLE

Class IV Lupus Nephritis: Iraj Salehi-Abari Class IV Lupus Nephritis: Most common/severe lupus nephritis > 50% of glomeruli are affected by LM Class IV subtypes: IV-S (segmental): < 50% of glomerular tuft IV-G (global): > 50% of glomerular tuft Acute (A), Chronic (C), Acute and chronic (A/C) SLE

Other Renal involvements: Iraj Salehi-Abari Other Renal involvements: Tubulointerstitial disorder Renovascular disease Silent Lupus Nephritis Overlap of Lupus and ANCA associated GN Renal limited lupus-like nephritis Glomerular podocytopathy Collapsing glomerulosclerosis SLE

Applications of Kidney Biopsy: Iraj Salehi-Abari Applications of Kidney Biopsy: Treatment planning and guideline Detection of activity and chronicity index Diagnosis Detection of complicating lesions SLE

Indications of Kidney Biopsy: Iraj Salehi-Abari Indications of Kidney Biopsy: Cases with proteinuria > 500 mg/24 hr Cases with telescopic urine Cases with worsening kidney function Cases with evidence of renal involvement Cases with elevated anti-dsDNA and low C All cases SLE