1. “Systemic Lupus Erythematosus” Renal features
Iraj Salehi-Abari
“Systemic Lupus Erythematosus” Renal features
Iraj Salehi-Abari MD.,
Internist
Rheumatologist
SLE

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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