Introduction

Lupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE) that can result in end-stage renal disease. SLE patients should be monitored by performing urinalysis at regular check-up appointments to rule out proteinuria.

Classification

WHO classification
  • class I: normal kidney
  • class II: mesangial glomerulonephritis
  • class III: focal (and segmental) proliferative glomerulonephritis
  • class IV: diffuse proliferative glomerulonephritis
  • class V: diffuse membranous glomerulonephritis
  • class VI: sclerosing glomerulonephritis

Class IV (diffuse proliferative glomerulonephritis) is the most common and severe form. Renal biopsy characteristically shows the following findings:
  • glomeruli shows endothelial and mesangial proliferation, 'wire-loop' appearance
  • if severe, the capillary wall may be thickened secondary to immune complex deposition
  • electron microscopy shows subendothelial immune complex deposits
  • granular appearance on immunofluorescence

Clinical features

Management

Management
  • treat hypertension
  • corticosteroids if clinical evidence of disease
  • immunosuppressants e.g. azathioprine/cyclophosphamide