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Lupus Nephritis

Neena R. Gupta, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • The renal manifestation of systemic lupus erythematosus (SLE)

  • American College of Rheumatology (ACR) criteria: persistent proteinuria >500 mg/day or ≥3 on dipstick and/or presence ...

DIAGNOSIS

HISTORY

Assess for risk factors and other signs/symptoms of SLE: rash, photosensitivity, arthritis, neurologic complaints, fever, weight loss, alopecia. 

PHYSICAL EXAM

  • Hypertension, fever

  • Pleura...

TREATMENT

GENERAL MEASURES

  • Monitor bone density; optimize vitamin D and calcium intake in patients on glucocorticoid therapy.

  • Low-salt diet for hypertension and edema. For eGFR <60 mL: Follow Nationa...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Monitor urine protein-to-creatinine ratio, urine microscopy, serum albumin and creatinine, antibody titers (especially anti-dsDNA), C3, C4, BP a...

REFERENCES

1
Hahn BH, McMahon MA, Wilkinson A, et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken).  2012;6...

ADDITIONAL READING

  • Almaani S, Meara A, Rovin BH. Update on lupus nephritis. Clin J Am Soc Nephrol.  2017;12(5):825–835. [View Abstract on OvidMedline]

  • Kidney Disease: Improving Global Outcomes (KD...

CODES

ICD10

M32.14 Glomerular disease in systemic lupus erythematosus 

ICD9

  • 710.0 Systemic lupus erythematosus

  • 583.81 Nephritis and nephropathy, not specified as acute or chronic, in diseases classified e...

CLINICAL PEARLS

  • Early diagnosis, correct classification (requires renal biopsy), and rapid treatment improve renal survival in patients with LN.

  • Treat proliferative/progressive LN with a short inductio...

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