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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Renal disease (lupus nephritis) develops in 50% of patients with lupus at some time. There is a broad spectrum of severity; it is often asymptomatic but may result in hypertension or renal failure.
Autoimmune Disorders across the Lifespan
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
SLE is a Th2-mediated autoimmune disorder and is a chronic multisystem inflammation of the skin, joints, kidney, and brain that can be intermittent, constant, active, or quiescent. Its cause is not fully known. The incidence of SLE in the United States is 0.1%. Approximately 90% of those affected are women, predominately of childbearing age, and of African-American descent. About 10–12% of patients with SLE have a positive family history. Clinical symptoms consist of the lupus triad of fever, joint pain, and rash. Photosensitivity and ultraviolet exposure are the most widely accepted triggers associated with development and flares of SLE. Lupus nephritis is among the most common clinical complications and occurs in up to 74% of patients, accounting for significant morbidity and mortality particularly among ethnic minorities.14
Autoimmune disorders
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
There is an increased risk of pre-eclampsia and fetal loss for women with SLE, especially in those with pre-existing hypertension, nephritis and the presence of anti-phospholipids1. Lupus nephritis is a common and more serious complication affecting up to 70% of those with SLE. Antibodies cause inflammatory damage in the nephron. Signs of lupus nephritis include proteinuria, haematuria and pyuria. Outside of pregnancy renal biopsy is used to diagnose lupus nephritis1. Features of lupus nephritis overlap with pre-eclampsia and distinguishing between the conditions will require laboratory assessment. The two conditions may occur together1.
Pathological mechanisms of abnormal iron metabolism and mitochondrial dysfunction in systemic lupus erythematosus
Published in Expert Review of Clinical Immunology, 2021
Chris Wincup, Natalie Sawford, Anisur Rahman
One particular example in which abnormal iron metabolism and mitochondrial dysfunction may occur is within the kidney. Lupus nephritis is a serious manifestation of the disease, which if not promptly identified and adequately treated can result in irreversible damage and in some cases lead to end-stage renal failure [requiring renal replacement therapy]. The most common cause of renal injury is glomerulonephritis, in which there is inflammation within the glomerulus. This is an important site of nutrient reabsorption and as such has the highest concentration of mitochondria within the kidney [75]. At present, very little is known with regards to the precise way in which the glomerulus handles circulating iron but previous studies have noted that podocytes [a specialist glomerular epithelial cell type found within Bowman’s capsule] are capable of taking up iron bound to transferrin and store it as ferritin [76]. As a result, some authors have proposed elevated urinary transferrin levels to be a useful biomarker of potentially active lupus nephritis [77].
Management of cardiovascular disease in patients with systemic lupus erythematosus
Published in Expert Opinion on Pharmacotherapy, 2020
Paramarjan Piranavan, Andras Perl
There is considerable literature claiming that the traditional Framingham score used to calculate the risk in the general population would not clearly predict the 10-year risk among SLE patients as they do not include lupus-specific risk factors such as accelerated inflammation, thrombosis, vasospasm, vasculitis, and endothelial dysfunction into account. Few studies have clearly demonstrated the benefits of diet, exercise, and behavioral modifications in improving the cardiovascular health of lupus patients. Identifying potential risk factors such as hypertension, hyperlipidemia, smoking among SLE patients, and treating hyperlipidemia regardless of their risk scores may be the first step in reducing mortality. Chronic kidney disease with or without lupus nephritis needs to be aggressively managed as preventing the progression of kidney disease will improve the cardiovascular morbidity and mortality in SLE patients.
Systemic lupus erythematosus: nothing stale her infinite variety
Published in Modern Rheumatology, 2018
Renal disease develops in more than half of SLE patients, and represents the first clinical manifestation of SLE in 15–20% [31]. Lupus nephritis is an important cause of morbidity and even mortality in patients with SLE and has diverse morphologic manifestations with varying clinical presentations and consequences. The pathogeneses vary involving immune complex deposit, endothelial injury, podocytopathy or tubulointerstitial injury thus leading to various prognosis with different pathological findings. Lupus nephritis is, by definition, an IgG dominant immune complex disease and the pattern/location of the deposition determines the resulting histopathological pattern. The varying glomerular immune complex patterns are diagnosed according to the International Society of Nephrology-Renal Pathological Society modification of the WHO criteria (ISN/RPS) classification that include predominantly mesangial deposits (classes I and II), subendothelial deposits with endocapillary hypercellularity or prominent duplication of glomerular basement membranes, often with necrotizing and crescentic lesions (classes III and IV, focal and diffuse) or membranous forms (class V). Renal biopsy plays a crucial role in the diagnosis of the specific form of lupus nephritis in the diagnosis of both SLE and lupus nephritis as well as determining the treatment strategy of the disease [32]. Immuno-suppressive therapy is essential for active lesions and physician need to be aware that it has minimal effect on scarring and involves considerable toxicity.