Lupus nephritis

- Overt renal disease occurs in at least one thrid of SLE patients and of these, 25% reach ESRF within 10 years

Classification of lupus nephritis (International Society of Nephrology/Renal Pathological Society 2004)
Class I (Minimal mesangial)
- immune deposits but normal on light microscopy.
- asymptomatic

Class II (Mesangial proliferative)
- mesangial hypercellularity and matrix expansion
- mild renal disease

Class III (Focal)
- involving less than 50% of glomeruli with subdivisions for active or chronic lesions
- presents with hematuria and proteinuria

Class IV (Diffuse)
- involving more than 50% of glomeruli
- classified by the presence of segmental and global lesions as well as active and chronic lesions
- most common and most severe form
- progression to nephrotic syndrome, hypertension and renal insufficiency

Class V (membranous)
- good prognosis

Class VI (advanced sclerosing)
- more than 90% globally sclerosed glomeruli without residual activity
- progressive renal failure

- double stranded DNA levels correlate with lupus nephritis
- drug induced lupus rarely presents with nephritis

Management
- Type 1 requires no treatment
- Type II runs benign course, some require steroids
- Type III, IV, V - steroids and cyclophosphamide / MMF for induction ; azathioprine and MMF for maintenance therapy