Lupus Nephritis

Neena R. Gupta, MD Reviewed 06/2018

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

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

Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012;2(2):139–274....

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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