eMedicine Specialties > Rheumatology > Systemic Rheumatic Disease

Nephritis, Lupus: Multimedia

Author: Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Coauthor(s): Arati Karhadkar, MBBS, Fellow, Division of Rheumatology, Albert Einstein Medical Center, Philadelphia, PA; Eric Bloom, MD, Attending Physician, Division of Nephrology, Department of Internal Medicine; Division Chief, Nephrology; Nephrology Fellowship Program Director, Albert Einstein Medical Center
Contributor Information and Disclosures

Updated: Jun 23, 2009

Multimedia

Mesangial proliferative lupus nephritis with mode...Media file 1: Mesangial proliferative lupus nephritis with moderate mesangial hypercellularity. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class II (hematoxylin and eosin stain; 200X magnification).
Mesangial proliferative lupus nephritis with mode...

Mesangial proliferative lupus nephritis with moderate mesangial hypercellularity. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class II (hematoxylin and eosin stain; 200X magnification).

Focal lupus nephritis. International Society of P...Media file 2: Focal lupus nephritis. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class III (hematoxylin and eosin stain; 100X magnification).
Focal lupus nephritis. International Society of P...

Focal lupus nephritis. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class III (hematoxylin and eosin stain; 100X magnification).

Focal lupus nephritis, immunofluorescence. Intern...Media file 3: Focal lupus nephritis, immunofluorescence. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class III (200X magnification).
Focal lupus nephritis, immunofluorescence. Intern...

Focal lupus nephritis, immunofluorescence. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class III (200X magnification).

Diffuse lupus nephritis with hypertensive vascula...Media file 4: Diffuse lupus nephritis with hypertensive vascular changes. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class IV (hematoxylin and eosin stain; 200X magnification).
Diffuse lupus nephritis with hypertensive vascula...

Diffuse lupus nephritis with hypertensive vascular changes. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class IV (hematoxylin and eosin stain; 200X magnification).

Diffuse lupus nephritis with early crescent forma...Media file 5: Diffuse lupus nephritis with early crescent formation. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class IV (hematoxylin and eosin stain; 200X magnification).
Diffuse lupus nephritis with early crescent forma...

Diffuse lupus nephritis with early crescent formation. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class IV (hematoxylin and eosin stain; 200X magnification).

Diffuse lupus nephritis with extensive crescent f...Media file 6: Diffuse lupus nephritis with extensive crescent formation (rapidly progressive glomerulonephritis). International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class IV (hematoxylin and eosin stain; 200X magnification).
Diffuse lupus nephritis with extensive crescent f...

Diffuse lupus nephritis with extensive crescent formation (rapidly progressive glomerulonephritis). International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class IV (hematoxylin and eosin stain; 200X magnification).

Membranous lupus nephritis. International Society...Media file 7: Membranous lupus nephritis. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class V (hematoxylin and eosin stain; 200X magnification).
Membranous lupus nephritis. International Society...

Membranous lupus nephritis. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class V (hematoxylin and eosin stain; 200X magnification).

Membranous lupus nephritis showing thickened glom...Media file 8: Membranous lupus nephritis showing thickened glomerular basement membrane. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class V (silver stain; 200X magnification).
Membranous lupus nephritis showing thickened glom...

Membranous lupus nephritis showing thickened glomerular basement membrane. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class V (silver stain; 200X magnification).

Advanced sclerosis lupus nephritis. International...Media file 9: Advanced sclerosis lupus nephritis. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class VI (hematoxylin and eosin stain; 100X magnification).
Advanced sclerosis lupus nephritis. International...

Advanced sclerosis lupus nephritis. International Society of Pathology/Renal Pathology Society (ISN/RPS) 2003 class VI (hematoxylin and eosin stain; 100X magnification).

More on Nephritis, Lupus

Overview: Nephritis, Lupus
Differential Diagnoses & Workup: Nephritis, Lupus
Treatment & Medication: Nephritis, Lupus
Follow-up: Nephritis, Lupus
Multimedia: Nephritis, Lupus
References

References

  1. D'Agati VD, Appel GB. Lupus Nephritis: Pathology and Pathogenesis. In: Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:1094-111.

  2. Grande JP. Mechanisms of progression of renal damage in lupus nephritis: pathogenesis of renal scarring. Lupus. 1998;7(9):604-10. [Medline].

  3. Rus V, Maury EE, Hochberg MC. Epidemiology of Systemic Lupus Erythematosus. In: Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:34-44.

  4. Dooley MA. Clinical and laboratory features of lupus nephritis. In: Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:1112-30.

  5. Gloor JM. Lupus nephritis in children. Lupus. 1998;7(9):639-43. [Medline].

  6. Brunner HI, Gladman DD, Ibañez D, Urowitz MD, Silverman ED. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum. Feb 2008;58(2):556-62. [Medline].

  7. Pisetsky DS, Gilkeson G, St. Clair EW. Systemic lupus erythematosus. Diagnosis and treatment. Med Clin North Am. Jan 1997;81(1):113-28. [Medline].

  8. Tsao BP. Update on human systemic lupus erythematosus genetics. Curr Opin Rheumatol. Sep 2004;16(5):513-21. [Medline].

  9. Nath SK, Kilpatrick J, Harley JB. Genetics of human systemic lupus erythematosus: the emerging picture. Curr Opin Immunol. Dec 2004;16(6):794-800. [Medline].

  10. Wong M, Tsao BP. Current topics in human SLE genetics. Springer Semin Immunopathol. Oct 2006;28(2):97-107. [Medline].

  11. Harley JB, Kelly JA, Kaufman KM. Unraveling the genetics of systemic lupus erythematosus. Springer Semin Immunopathol. Oct 2006;28(2):119-30. [Medline].

  12. Harley JB, Alarcón-Riquelme ME, Criswell LA, Jacob CO, Kimberly RP, Moser KL, et al. Genome-wide association scan in women with systemic lupus erythematosus identifies susceptibility variants in ITGAM, PXK, KIAA1542 and other loci. Nat Genet. Feb 2008;40(2):204-10. [Medline].

  13. Crow MK. Collaboration, genetic associations, and lupus erythematosus. N Engl J Med. Feb 28 2008;358(9):956-61. [Medline].

  14. Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. Feb 28 2008;358(9):929-39. [Medline].

  15. Mohan C, Adams S, Stanik V, Datta SK. Nucleosome: a major immunogen for pathogenic autoantibody-inducing T cells of lupus. J Exp Med. May 1 1993;177(5):1367-81. [Medline].

  16. Muller S, Dieker J, Tincani A, Meroni PL. Pathogenic anti-nucleosome antibodies. Lupus. 2008;17(5):431-6. [Medline].

  17. Crow MK. Interferon pathway activation in systemic lupus erythematosus. Curr Rheumatol Rep. Dec 2005;7(6):463-8. [Medline].

  18. Rönnblom L, Eloranta ML, Alm GV. The type I interferon system in systemic lupus erythematosus. Arthritis Rheum. Feb 2006;54(2):408-20. [Medline].

  19. Rönnblom L, Pascual V. The innate immune system in SLE: type I interferons and dendritic cells. Lupus. 2008;17(5):394-9. [Medline].

  20. Arbuckle MR, McClain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med. Oct 16 2003;349(16):1526-33. [Medline].

  21. Yung S, Chan TM. Anti-DNA antibodies in the pathogenesis of lupus nephritis--the emerging mechanisms. Autoimmun Rev. Feb 2008;7(4):317-21. [Medline].

  22. Simón JA, Cabiedes J, Ortiz E, Alcocer-Varela J, Sánchez-Guerrero J. Anti-nucleosome antibodies in patients with systemic lupus erythematosus of recent onset. Potential utility as a diagnostic tool and disease activity marker. Rheumatology (Oxford). Feb 2004;43(2):220-4. [Medline].

  23. Su Y, Jia RL, Han L, Li ZG. Role of anti-nucleosome antibody in the diagnosis of systemic lupus erythematosus. Clin Immunol. Jan 2007;122(1):115-20. [Medline].

  24. Bigler C, Lopez-Trascasa M, Potlukova E, Moll S, Danner D, Schaller M, et al. Antinucleosome antibodies as a marker of active proliferative lupus nephritis. Am J Kidney Dis. Apr 2008;51(4):624-9. [Medline].

  25. Marto N, Bertolaccini ML, Calabuig E, Hughes GR, Khamashta MA. Anti-C1q antibodies in nephritis: correlation between titres and renal disease activity and positive predictive value in systemic lupus erythematosus. Ann Rheum Dis. Mar 2005;64(3):444-8. [Medline].

  26. Sinico RA, Radice A, Ikehata M, Giammarresi G, Corace C, Arrigo G, et al. Anti-C1q autoantibodies in lupus nephritis: prevalence and clinical significance. Ann N Y Acad Sci. Jun 2005;1050:193-200. [Medline].

  27. Grande JP, Balow JE. Renal biopsy in lupus nephritis. Lupus. 1998;7(9):611-7. [Medline].

  28. Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. Feb 2004;15(2):241-50. [Medline].

  29. Houssiau FA, Ginzler EM. Current treatment of lupus nephritis. Lupus. 2008;17(5):426-30. [Medline].

  30. Dooley MA, Falk RJ. Immunosuppressive therapy of lupus nephritis. Lupus. 1998;7(9):630-4. [Medline].

  31. Dooley MA, Ginzler EM. Newer therapeutic approaches for systemic lupus erythematosus: immunosuppressive agents. Rheum Dis Clin North Am. Feb 2006;32(1):91-102, ix. [Medline].

  32. Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group. N Engl J Med. Oct 19 2000;343(16):1156-62. [Medline].

  33. Ginzler EM, Dooley MA, Aranow C, Kim MY, Buyon J, Merrill JT. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med. Nov 24 2005;353(21):2219-28. [Medline].

  34. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med. Mar 4 2004;350(10):971-80. [Medline].

  35. [Best Evidence] Appel GB, Contreras G, Dooley MA, Ginzler EM, Isenberg D, Jayne D, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol. May 2009;20(5):1103-12. [Medline].

  36. Gourley MF, Austin HA 3rd, Scott D, et al. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med. Oct 1 1996;125(7):549-57. [Medline].

  37. Ciruelo E, de la Cruz J, Lopez I, Gomez-Reino JJ. Cumulative rate of relapse of lupus nephritis after successful treatment with cyclophosphamide. Arthritis Rheum. Dec 1996;39(12):2028-34. [Medline].

  38. Somers EC, Marder W, Christman GM, Ognenovski V, McCune WJ. Use of a gonadotropin-releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus. Arthritis Rheum. Sep 2005;52(9):2761-7. [Medline].

  39. Silverman GJ. Anti-CD20 therapy in systemic lupus erythematosus: a step closer to the clinic. Arthritis Rheum. Feb 2005;52(2):371-7. [Medline].

  40. Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ. B cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose-escalation trial of rituximab. Arthritis Rheum. Aug 2004;50(8):2580-9. [Medline].

  41. Leandro MJ, Cambridge G, Edwards JC, Ehrenstein MR, Isenberg DA. B-cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 24 patients. Rheumatology (Oxford). Dec 2005;44(12):1542-5. [Medline].

  42. Ng KP, Leandro MJ, Edwards JC, Ehrenstein MR, Cambridge G, Isenberg DA. Repeated B cell depletion in treatment of refractory systemic lupus erythematosus. Ann Rheum Dis. Jul 2006;65(7):942-5. [Medline].

  43. Looney RJ, Anolik J, Sanz I. New therapies for systemic lupus erythematosus: cellular targets. Rheum Dis Clin North Am. Feb 2006;32(1):201-15, xi. [Medline].

  44. Furie R. Abetimus sodium (riquent) for the prevention of nephritic flares in patients with systemic lupus erythematosus. Rheum Dis Clin North Am. Feb 2006;32(1):149-56, x. [Medline].

  45. Kirou KA, Salmon JE, Crow MK. Soluble mediators as therapeutic targets in systemic lupus erythematosus: cytokines, immunoglobulin receptors, and the complement system. Rheum Dis Clin North Am. Feb 2006;32(1):103-19, ix. [Medline].

  46. Ponticelli C, Moroni G. Flares in lupus nephritis: incidence, impact on renal survival and management. Lupus. 1998;7(9):635-8. [Medline].

  47. Bogdanovic R, Nikolic V, Pasic S, Dimitrijevic J, Lipkovska-Markovic J, Eric-Marinkovic J. Lupus nephritis in childhood: a review of 53 patients followed at a single center. Pediatr Nephrol. Jan 2004;19(1):36-44. [Medline].

  48. Khamashta MA. Systemic lupus erythematosus and pregnancy. Best Pract Res Clin Rheumatol. Aug 2006;20(4):685-94. [Medline].

  49. Petri M. The Hopkins Lupus Pregnancy Center: ten key issues in management. Rheum Dis Clin North Am. May 2007;33(2):227-35, v. [Medline].

  50. Witter FR. Management of the high-risk lupus pregnant patient. Rheum Dis Clin North Am. May 2007;33(2):253-65, v-vi. [Medline].

Further Reading

Keywords

lupus nephritis, systemic lupus erythematosus, SLE, end-stage renal disease, ESRD, end-stage kidney disease, chronic kidney disease, chronic renal disease, chronic renal failure, glomerulonephritis, hematuria, renal failure, kidney failure, mesangial nephritis, hypertension, proteinuria, active lupus nephritis, focal proliferative lupus nephritis, diffuse proliferative lupus nephritis, mesangial lupus nephritis, membranous lupus nephritis, active nephritis, sclerosing lupus nephritis, mesangial proliferative lupus nephritis, focal lupus nephritis, diffuse lupus nephritis, focal sclerosing lupus nephritis, diffuse segmental proliferative lupus nephritis, diffuse global proliferative lupus nephritis, diffuse segmental sclerosing lupus nephritis, diffuse global sclerosing lupus nephritis, advanced sclerosis lupus nephritis

Contributor Information and Disclosures

Author

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB  Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting

Coauthor(s)

Arati Karhadkar, MBBS, Fellow, Division of Rheumatology, Albert Einstein Medical Center, Philadelphia, PA
Disclosure: Nothing to disclose.

Eric Bloom, MD, Attending Physician, Division of Nephrology, Department of Internal Medicine; Division Chief, Nephrology; Nephrology Fellowship Program Director, Albert Einstein Medical Center
Eric Bloom, MD is a member of the following medical societies: American Society of Nephrology and National Kidney Foundation
Disclosure: Nothing to disclose.

Medical Editor

Carlos J Lozada, MD, Director of Rheumatology Fellowship Program, Professor, Department of Medicine, Division of Rheumatology and Immunology, University of Miami Miller School of Medicine
Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology
Disclosure: Pfizer Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ajay K Singh, MB, MRCP, MBA, Associate Professor of Medicine, Harvard Medical School; Clinical Chief, Renal Division, Director of Dialysis, Brigham and Women's Hospital; Consulting Staff, Faulkner Hospital
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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