Lupus nephritis: Difference between revisions

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   Name          = Lupus nephritis |
   Name          = Lupus nephritis |
   Image          = dpgn.jpg|
   Image          = dpgn.jpg|
   Caption        = Type IV lupus nephritis: The classic "flea-bitten" appearance of the cortical surface in the diffuse proliferative glomerulonephritides. (Courtesy of Ed Uthman, MD)]]|
   Caption        = <nowiki>Type IV lupus nephritis: The classic "flea-bitten" appearance of the cortical surface in the diffuse proliferative glomerulonephritides. (Courtesy of Ed Uthman, MD)]]</nowiki>|
  DiseasesDB    = |
  ICD10          = {{ICD10|N|08|5|n|00}} |
  ICD9          = {{ICD9|583.81}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000481 |
  MeshID        = D008181 |
}}
}}
{{Lupus nephritis}}
{{Lupus nephritis}}
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'''For patient information, click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information, click [[{{PAGENAME}} (patient information)|here]]'''


{{CMG}}; {{AE}} {{CZ}}; [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]; {{RT}}
{{CMG}}; {{AE}}[[User:Okamal|Omer Kamal, M.D.]][mailto:okamal@bidmc.harvard.edu <nowiki>[2]</nowiki>] {{CZ}}; [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]; {{AIDA}}{{RT}}''' '''


{{SK}} Nephritis - lupus; lupus glomerular disease
{{SK}} Nephritis - lupus; lupus glomerular disease


==Diagnosis==
== [[Lupus nephritis overview|Overview]] ==
==Symptoms==
Sufferers of lupus nephritis may or may not have symptoms of [[kidney disease]], but it can manifest itself through:
* [[Weight gain]]
* Darker foamy [[urine]]
* [[Edema|Swelling]] around the eyes, legs, ankles or fingers.


Furthermore, patients may suffer from other symptoms of lupus unrelated to kidney function.  Such symptoms can include
== [[Lupus nephritis historical perspective|Historical Perspective]] ==
* [[Arthritis]] - joint pains
* [[Fevers]]
* Gastro-intenstinal disturbances
* [[Headaches]]
* [[Fatigue (physical)|Fatigue]]
* Swollen joints


==Physical Examination==
== [[Lupus nephritis classification|Classification]] ==
===Vitals===
* [[Elevated body temperature]]
* [[Hypertension|High blood pressure]]


===Eyes===
== [[Lupus nephritis pathophysiology|Pathophysiology]] ==
* Peri-orbital puffiness can be noticed in patients with advanced disease having [[renal failure]].


===Extremities===
== [[Lupus nephritis causes|Causes]] ==
* [[Edema|Swelling]] around the legs, ankles or fingers.
* Swollen joints


==Laboratory Findings==
== [[Differentiating lupus nephritis from other diseases|Differentiating Lupus nephritis from other Diseases]] ==
Tests that may be done include:


* [[ANA]] titer.
== [[Lupus nephritis epidemiology and demographics|Epidemiology and Demographics]] ==
* [[BUN]] and [[creatinine]].
* [[Lupus test]].
* [[Urinalysis]].
* Urine [[immunoglobulin light chain]]


==Chest X-ray==
== [[Lupus nephritis risk factors|Risk Factors]] ==
* Shows signs of fluid collection in the lungs in very severe cases.
==[[Lupus nephritis screening|Screening]]==


==Treatment==
== [[Lupus nephritis natural history, complications and prognosis|Natural History, Complications and Prognosis]] ==
===Medical Therapy===
* Medicines which decrease swelling, lower blood pressure and decrease inflammation by suppressing the immune system.
* Patients may need to monitor intake of protein, sodium, and potassium.
* Patients with severe disease should restrict their sodium intake to 2 grams per day and limit fluid as well.
* Depending on the histology, renal function and degree of [[proteinuria]], patients may require steroid therapy or [[chemotherapy]] regimens such as cyclophosphamide, [[azathioprine]], mycophenolate mofetil or [[cyclosporine]].
* [[Dialysis]] to control symtopms of [[kidney failure]].  There are two types of dialysis, [[hemodialysis]] and [[peritoneal dialysis]].


The drug therapy for lupus nephritis depends on the severity of the disease.
== Diagnosis ==
* For mild disease, [[corticosteroid]]s are generally prescribed. More severe disease requires treatment with immunosuppressant agents.  The two most commonly used agents are [[mycophenolate mofetil]] and intravenous [[cyclophosphamide]].  One recent study compared these two drugs.<ref name="Ginzler">Ginzler EM, Dooley MA, Aranow C, Kim MY, et al. "Mycophenolate Mofetil or Intravenous Cyclophosphamide for Lupus Nephritis." New England Journal of Medicine. 353:21. 2219-2229. 24 November 2005.</ref>
[[Diagnostic criteria]] | [[Lupus nephritis history and symptoms|History and Symptoms]] | [[Lupus nephritis physical examination|Physical Examination]] | [[Lupus nephritis laboratory findings|Laboratory Findings]] | [[Lupus nephritis chest x ray|Chest X Ray]] | [[Lupus nephritis CT|CT]] | [[Lupus nephritis MRI|MRI]] | [[Lupus nephritis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Lupus nephritis other imaging findings|Other Imaging Findings]] | [[Lupus nephritis other diagnostic studies|Other Diagnostic Studies]]
* The authors showed that patients with Class III or IV disease are more likely to benefit from [[mycophenolate mofetil]] as compared to [[cyclophosphamide]].  As a result, mycophenolate mofetil is now considered to be the first-line therapy for this disease.


===Surgical Therapy===
== Treatment ==
* A kidney [[transplant]] may be recommended.  People with active lupus should not have a transplant because the condition can occur in the transplanted kidney.


==References==
[[Lupus nephritis medical therapy|Medical Therapy]] | [[Lupus nephritis surgery|Surgery]] | [[Lupus nephritis primary prevention|Primary Prevention]] | [[Lupus nephritis secondary prevention|Secondary Prevention]] | [[Lupus nephritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Lupus nephritis future or investigational therapies|Future or Investigational Therapies]]
{{Reflist|2}}


==External links==
==Case Studies==
*[http://www.lupusclinicalstudy.com/ Lupus Nephritis Clinical Research Study]
[[Lupus nephritis case study one|Case #1]]
*[http://www.londonlupuscentre.co.uk/ London Lupus Centre - Treatment, Diagnosis, Research]
*[http://www.lupus.org/ Lupus Foundation of America, Inc.]
*[http://www.lupusresearchinstitute.org/ Lupus Research Institute]
*[http://www.lupusny.org/ S.L.E. Lupus Foundation]
*[http://www.lupusinternational.com/ Lupus International]


{{Nephrology}}
{{Nephrology}}

Latest revision as of 20:36, 19 July 2018

Lupus nephritis
Type IV lupus nephritis: The classic "flea-bitten" appearance of the cortical surface in the diffuse proliferative glomerulonephritides. (Courtesy of Ed Uthman, MD)]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2] Cafer Zorkun, M.D., Ph.D. [2]; Ujjwal Rastogi, MBBS [3]; Aida Javanbakht, M.D.Raviteja Guddeti, M.B.B.S. [4] 

Synonyms and keywords: Nephritis - lupus; lupus glomerular disease

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lupus nephritis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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