genitourinary disorders
Lupus Nephritis
Diagnosis of Lupus Nephritis
Urinalysis and serum creatinine (all patients with SLE) Renal biopsy None Diagnosis is suspected in all patients with SLE, particularly in patients who have proteinuria, microscopic hematuria, red blood cell (RBC) casts, or Hypertension . Diagnosis is also suspected in patients with unexplained hypertension, elevated serum creatinine levels, or abnormalities on urinalysis who have clinical features suggesting SLE. Urinalysisis done and serum creatinine is measured. Elevated anti–double-stranded-DNA (anti-dsDNA) antibody titers and low complement (C3 and C4) levels often indicate active lupus nephritis and support the diagnosis. If the aforementioned studies are abnormal,renal biopsyis usually done to confirm the diagnosis and classify the disorder histologically. Histologic classification helps determine prognosis and direct treatment. Some of the histologic subtypes are similar to other glomerulopathies; eg, membranous lupus nephritis is histologically similar to idiopathic Membranous Nephropathy and diffuse proliferative lupus nephritis is histologically similar to The top image shows mesangial deposition of IgM (immunofluorescence with anti-IgM, original magnification×400). In the bottom image, mesangial dense immune complex deposits and reticular aggregates within endothelial cell cytoplasm are seen on transmission electron microscopy (×8000). Image provided by Agnes Fogo, MD, and the American Journal of Kidney Diseases'Atlas of Renal Pathology(see www.ajkd.org). Focal lupus nephritis is characterized by endocapillary proliferation caused by immune complex deposits involving<50% of glomeruli in a biopsy specimen. Image provided by Agnes Fogo, MD, and the American Journal of Kidney Diseases'Atlas of Renal Pathology(see www.ajkd.org). Diffuse lupus nephritis is characterized by endocapillary proliferation caused by immune complex deposits involving>50% of glomeruli in a biopsy specimen. Image provided by Agnes Fogo, MD, and the American Journal of Kidney Diseases'Atlas of Renal Pathology(see www.ajkd.org). Diffuse holes, small spikes, and mild mesangial expansion with small areas of pink staining indicate mesangial immune complex deposits (Jones silver stain,×400). Image provided by Agnes Fogo, MD, and the American Journal of Kidney Diseases'Atlas of Renal Pathology(see www.ajkd.org). Renal function and SLE activity should be monitored regularly. A rising serum creatinine level reflects deteriorating renal function, while falling serum C3 and C4 levels or a rising anti-dsDNA antibody titer suggests increased disease activity. 