lupus nephritis


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Related to lupus nephritis: systemic lupus erythematosus

nephritis

 [nĕ-fri´tis] (pl. nephri´tides)
inflammation of the kidney; a focal or diffuse proliferative or destructive disease that may involve the glomerulus, tubule, or interstitial renal tissue. Called also Bright's disease. The most usual form is glomerulonephritis, that is, inflammation of the glomeruli, which are clusters of renal capillaries. Damage to the membranes of the glomeruli results in impairment of the filtering process, so that blood and proteins such as albumin pass out into the urine. Depending on the symptoms it produces, nephritis is classified as acute nephritis, chronic nephritis, or nephrosis (called also the nephrotic syndrome).
Acute Nephritis. This occurs most frequently in children and young people and seems to strike those who have recently suffered from sore throat, scarlet fever, and other infections caused by streptococci; it is believed to originate as an immune response on the part of the kidney. An attack may produce no symptoms, but more often there are headaches, a rundown feeling, back pain, and perhaps slight fever. The urine may look smoky, bloody, or wine-colored. Analysis of the urine shows the presence of erythrocytes, albumin, and casts. Another symptom is edema of the face or ankles, more common in the morning than in the evening. The blood pressure usually rises during acute nephritis, and in severe cases hypertension may be accompanied by convulsions.

Treatment consists chiefly of bed rest and a carefully controlled diet. Penicillin is often used if an earlier streptococcal infection is still lingering. Recovery is usually complete. In a small percentage of cases, however, acute nephritis resists complete cure. It may subside for a time and then become active again, or it may develop into chronic nephritis. Dialysis may be indicated in patients with fluid overload that is refractory to diuretics, or who become clinically uremic.
Chronic Nephritis. Chronic nephritis may follow a case of acute nephritis immediately or it may develop after a long interval during which no symptoms have been present. Many cases of chronic nephritis occur in people who have never had the acute form of the disease. Symptoms are often unpredictable and variable from case to case, but there is almost always steady, progressive, permanent damage to the kidneys.

Chronic nephritis generally moves through three stages. In the first stage, the latent stage, there are few outward symptoms. There may be slight malaise, but often the only indication of the disease is the presence of albumin and other abnormal substances in the urine. If a blood count is made during this stage, anemia may be found. There is no special treatment during the latent stage of chronic nephritis. The patient can live a normal life but should avoid extremes of fatigue and exposure and should eat a well balanced diet.

The first stage may be followed by a second stage, in which edema occurs in the face, legs, or arms. The main treatment in this stage consists of a low-protein, low-sodium diet and diuretics. Steroid hormones may be helpful.

At the final stage of chronic nephritis is end-stage renal disease. Treatments are kidney transplant and dialysis. At any stage of chronic nephritis it is particularly important to avoid other infections, which will aggravate the condition.

There is no known cure for chronic nephritis, although the progress of the disease can be delayed, so that the patient can live an almost normal life for years. Many patients are being helped by repeated purification of their uremic blood by hemodialysis or peritoneal dialysis, or by transplantation.
glomerular nephritis glomerulonephritis.
interstitial nephritis nephritis with increase of interstitial tissue and thickening of vessel walls and malpighian corpuscles; it may be due to overuse of analgesics, mercury poisoning, gout, or any of various other conditions.
lupus nephritis glomerulonephritis associated with systemic lupus erythematosus.
potassium-losing nephritis see under nephropathy.
radiation nephritis kidney damage caused by ionizing radiation; symptoms include glomerular and tubular damage, hypertension, and proteinuria, sometimes leading to renal failure. It may be acute or chronic, and some varieties do not manifest until years after the radiation exposure.
salt-losing nephritis salt-losing nephropathy.
transfusion nephritis nephropathy following transfusion from an incompatible donor as a result of the hemoglobin of the hemolyzed red blood cells being deposited in the renal tubules.
tubulointerstitial nephritis nephritis of the renal tubules and interstitial tissues, usually seen secondary to a drug sensitization, systemic infection, graft rejection, or autoimmune disease. Characteristics include lymphocytes in interstitial infiltrate and within tubules, mild hematuria, and pyuria. Acute tubulointerstitial nephritis is usually seen as a complication of infection or allergy. Chronic tubulointerstitial nephritis is when the condition has progressed to interstitial fibrosis with shrunken kidneys, a lowered glomerular filtration rate, and danger of renal failure.

lu·pus ne·phri·tis

a form of glomerluponephritis occuring in some people with systemic lupus erythematosus, although it may also be renally limited. May be characterized by hematuria, proteinuria, or both, with or without associated hypertension. Can lead to a progressive or fulminant course resulting in renal failure. May present as the progressive or fulminant course resulting in renal failure. May also present as the nephrotic syndrome in some people; renal biopsies in these people are classified by the World Health Organization criteria and by activity and chronicity. Biopsy findings take the forms of: no apparent disease (WHO class I), mesangial proliferation (WHO class II), focal proliferative lesions (WHO class III), diffuse proliferative lesions (WHO class IV), membranous lesions (WHO class V), or end stage lesions (WHO class VI).

lupus nephritis

Lupus glomerular disease, lupus nephropathy Rheumatology Any nephropathy seen in systemic lupus erythematosus  Pathogenesis Classes II-V are attributed to deposition of DNA-anti-DNA immune complexes containing Igs, complement,  cryoglobulins Management Prednisone, cyclophosphamide.
Lupus nephritis–WHO classification
Class I Normal–rarely recognized
Class II Mesangial lupus GN–10% of Pts Minimal clinical disease, mild hematuria, mild proteinuria LM Granular mesangial deposition of Ig and complement
Class III Focal proliferative glomerulonephritis–±13 of Pts Moderate clinical manifestations, recurrent hematuria, moderate proteinuria, possible progression to renal failure LM Focal swelling and proliferation of endothelial and mesangial cells, neutrophil infiltration, fibrinoid debris
Class IV Diffuse proliferative GN–45-50% Overtly symptomatic, microscopic or gross hematuria, proteinuria ± nephrotic syndrome, ± hypertension, often ↓ GFR LM Global glomerular involvement, proliferation of endothelial and mesangial, and sometimes epithelial cells
Class V Membranous GN–10% Overtly symptomatic, microscopic or gross hematuria, severe proteinuria with nephrotic syndrome, HTN, ↓ GFR LM Thickening of capillary walls similar to idiopathic membranous GN
GFR Glomerular filtration rate GN Glomerulonephritis  LM Light microscopy WHO classification  
Note: Plasmapheresis does not improve the clinical outcome in LN NEJM 1992; 326:1373oa

lu·pus neph·ri·tis

(lū'pŭs nĕ-frī'tis)
Glomerulonephritis occurring in some patients with systemic lupus erythematosus, characterized by hematuria and a progressive course culminating in renal failure.

nephritis

inflammation of the kidney; a focal or diffuse proliferative or destructive disease that may involve the glomerulus, tubule or interstitial renal tissue. See also glomerulonephritis, interstitial nephritis (below), nephrosis, pyelonephritis.

autoimmune nephritis
embolic nephritis
caused by infected emboli lodging in renal vessels. One or more abscesses may develop, causing signs referable to toxemia. There may be intermittent pyuria. Renal dysfunction is likely only if most of the renal mass is destroyed.
glomerular nephritis
interstitial nephritis
a diffuse lesion characterized by interstitial inflammation and fibrosis, sometimes attributed to hematogenous infection with Leptospira spp. There is a secondary glomerular and vascular injury. It is manifested by polyuria, urine of low specific gravity, and terminal uremia.
lupus nephritis
glomerulonephritis associated with systemic lupus erythematosus.
parenchymatous nephritis
nephritis affecting the parenchyma of the kidney.
suppurative nephritis
a form accompanied by suppuration and abscessation of the kidney.
transfusion nephritis
nephropathy following transfusion from an incompatible donor.
References in periodicals archive ?
Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis.
The notion of the importance of combination is supported by the BELONG study that used ocrelizumab, a non-FDA approved fully humanized anti-CD20 monoclonal antibody, which demonstrated superior response compared to placebo when used in combination with fixed low-dose European lupus nephritis (ELNT) CYT but not in those receiving background MMF.
They found that lupus nephritis rarely developed in the transplanted kidneys of these lupus patients.
So even though three randomized trials have shown that efficacy and safety are equal to or better than cyclophosphamide in lupus nephritis, MMF is not approved," she said.
31-33) Some of the limitations that pathologists may encounter during examination of a renal biopsy are sample location (cortex versus medulla) and specimen adequacy, number of glomeruli, heterogeneity of glomerular lesions within a biopsy, transitions from one type of lesion to another during the course of lupus nephritis and SLE (Table 2), advanced parenchymal lesions, and occasional lack of correlation with clinical parameters.
A renal physician diagnosed a flare of lupus nephritis as a cause of the acute deterioration and an intravenous methylprednisone infusion was commenced.
Methods: Renal biopsies from 16 patients with lupus nephritis were reviewed for C4d deposition in the glomeruli and peritubular capillaries.
However, lupus nephritis may cause weight gain, high blood pressure, dark urine, or swelling around the eyes, legs, ankles, or fingers.
Benlysta's cost is reported to be its greatest disadvantage, however, physicians also mentioned the intravenous route of administration, perceived modest/poor efficacy and the lack of clinical efficacy in patient subsets, such as African Americans, lupus nephritis, CNS and severe SLE patients as disadvantages.
Treatment of lupus nephritis consists of induction followed by a maintenance phase.
para]]Grant Project Aims to Improve Lupus Nephritis Treatment[[/para]]

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