genitourinary disorders
Lupus Nephritis
Pathophysiology of Lupus Nephritis
Pathophysiology involves immune complex deposition with development of glomerulonephritis. The immune complexes consist of Nuclear antigens (especially DNA) High-affinity complement-fixing IgG antinuclear antibodies Antibodies to DNA Subendothelial, intramembranous, subepithelial, or mesangial deposits are characteristic. Wherever immune complexes are deposited, immunofluorescence staining is positive for complement and for IgG, IgA, and IgM in varying proportions. Epithelial cells may proliferate, forming crescents. Classification of lupus nephritis is based on histologic findings (see table). This syndrome may occur with or without lupus nephritis in up to one third of patients with SLE. The syndrome occurs in the absence of any other autoimmune process in 30 to 50% of affected patients. In Antiphospholipid Syndrome (APS) , circulating lupus anticoagulant causes microthrombi, endothelial damage, and cortical ischemic atrophy. Antiphospholipid syndrome nephropathy increases a patient’s risk of hypertension and renal insufficiency or failure compared with lupus nephritis alone. 