genitourinary disorders
Lupus Nephritis
Key Points
Nephritis, although clinically evident in only 50%, probably occurs in > 90% of patients with SLE. Obtain urinalysis and measure serum creatinine in all patients with SLE and renal biopsy if an unexplained abnormality is found in either, particularly in the presence of low C3 and C4 and elevated dsDNA. Initiate angiotensin inhibition for even mild hypertension and treat atherosclerotic risk factors aggressively. Treat active, potentially reversible nephritis with corticosteroids plusmycophenolatemofetil and/orcyclophosphamide. Continue maintenance therapy for at least 2 years, which typically includesmycophenolateand low-doseprednisone. 