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Feature Article

The many faces of lupus nephritis: when kidneys are involved in SLE

Rob MacGinley, Kathryn Ducharlet

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Abstract

Renal involvement occurs in at least half of cases of systemic lupus erythematosus (SLE). Four cases are discussed illustrating the diagnosis of the various types of lupus nephritis and their treatment. Early treatment with the combination of corticosteroids, hydroxychloroquine and either cyclophosphamide or mycophenolate mofetil is appropriate.

Key Points

  • Most patients with extrarenal systemic lupus erythematosus (SLE) will develop renal involvement and need lifelong six-monthly screening for urinary abnormalities to allow prompt and successful treatment.
  • The finding of haematuria in pregnancy and other health checks should be followed up with serological testing for lupus nephritis, particularly in people of Southeast Asian and Asian descent.
  • With the advent of mycophenolate mofetil and rituximab treatments for lupus nephritis, successful treatment of severe disease in young people now does not require the use of agents that cause long-term infertility (e.g. cyclophosphamide).
  • The burden of disease and medications needed can lead to noncompliance and resultant severe flares of SLE that have a high morbidity when subsequently treated.

    Picture credit: © Hywards/Stock.adobe.com

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