RENAL FEATURES OF SLE/SLE NEPHRITIS. Lupus nephritis is inflammation of kidneys caused by SLE.Systemic lupus erythematosus is an auto immune disease in which the body's immune system attacks the body's own cells and organs.SLE nephritis gets worse over time and leads to renal failure. Lupus is more common in woman than in men. 9 out of 10 lupus patients are women.It most often strikes during child bearing years.Lupus is also more common in poeple of asian or african background. SYMPTOMS OF LUPUS NEPHRITIS. 1.Sudden ,unexplained swelling ,especially in the extremities-feet,ankles,legs,fingers,arms or eyes. 2.Hematuria. 3.Elevated blood pressure. 4.Foamy appearance in urinedue to proteinuria 5.Increased urination ,especially at night. HYPERTENSION,HEMATURIA,PROTEINURIA, EDEMA &WEIGHT GAIN CLASSIFICATION OF LUPUS NEPHRITIS. Lupus nephritis is staged according to the classification revised by the international society of nephrology (ISN) amd Renal pathology society (RPS).in 2003.The classification is based on light microscopy, immunoflorescence and electron microscopy findings from renal biopsy specimens. ISN/RPS CLASSIFICATION CLASS I : MINIMAL MESANGIAL LUPUS NEPHRITIS. Histological features. *Normal glomeruli on light microscopy. *Mesangial immune deposits on immunoflorescence. CLASS II : MESANGIAL LUPUS NEPHRITIS. Histological features. Mesangial hypercellularity with mesangial immune deposits on immunoflorescence. CLASS III : FOCAL PROLIFERATIVE. LUPUS NEPHRITIS. Histological features. Focal proliferative glomerulonephritis involving <<50% of glomeruli.,typically with focal sub- endothelial immune deposits and leucocyte infiltration. CLASS IV : DIFFUSE PROLIFERATIVE LUPUS NEPHRITIS. Histological features. Diffuse proliferative glomerulonephritis involving >>>50 % of glomeruli ,typically diffuse sub -endothelial immune deposits. CLASS V : MEMBRANOUS LUPUS NEPHRITIS Histological features. Thickening of capillary walls. Global/segmental sub-epithelial immune deposits. CLASS VI : ADVANCED SCLEROSIS LUPUS NEPHRITIS. Histological features. Irreversible advanced disease. >>>90 % glomerulosclerosis. PATHOPHYSIOLOGY OF SLE Multiple influences are thought to underlie the pathogenesis of SLE like 1.Genetic factors. 2.Epigenetic modifications. 3.Environmental triggers. 4.Hormonal influences. 5.Aberrant immune mechanismslike Adaptive immune dysfunction. Innate immune dysfunction. LABORATORY DIAGNOSIS. Laboratory tests to evaluate renal function in SLE are 1.Blood urea nitrogen (BUN ) testing. 2.Serum creatinine assessment. 3.Urine analysis - to check for protein,RBC casts, and cellular casts. 4.Spot urine test for creatinine and protein concentration. Laboratory tests to evaluate SLE disease activity are 1.Antibodies to double stranded DNA (ds DNA) 2.Complement(C3,C4,and CH50.). 3.ESR. 4.C-reactive protein.(CRP). RENAL BIOPSY is considered in any patient with SLE who has clinical or laboratory evidence of active nephritis ,especially upon the first episode of nephritis . MANAGEMENT. THE PRINCIPAL GOAL OF THERAPY IN LUPUS NEPHRITIS IS TO NORMALISE RENAL FUNCTION OR,ATLEAST ,TO PREVENT THE PROGRESSIVE LOSS OF RENAL FUNCTION. Key points of American college of Rheumatology guidelines for managing lupus nephritis are as follows 1.Patients with clinical evidence of active, previously untreated lupus nephritis should have a RENAL BIOPSY to classify the disease according to ISN/RPS criteria. 2.All patients with lupus nephritis should receive background therapy with HYDROXYCHLOROQUINE ,unless contra indicated. 3.GLUCOCORTICOIDS along with CYCLOPHOSPHAMIDE intra venously (OR ) MYCOPHENOLATE MOFETIL orally should be administered to Patients with CLASS III/IV disese. Patients with class I/II nephritis do not require immunosuppressant therapy. 4.ACE INHIBITORS/ANGIOTENSIN RECEPTOR BLOCKERS should be administered if proteinuria exceeds 0.5 gm/day. 5.B.P should be maintained below 130/80 mm Hg. Patients with CLASS V. lupus nephritis are generally treated with prednisone for 1-3months ,followed by tapering for 1-2 years , if a response occurs. INVESTIGATIONAL THERAPIES FOR SLE NEPHRITIS. 1.Rituximab 2.Other anti-CD20 monoclonal antibodies like Ocrelizumab. Ofatumumab. Epratuzumab. TRU-015. 3.Belimumab. 4.Atacicept. 5.Abetimus. 6.Anti-cytokine therapies. Patients with end stage renal disease require DIALYSIS and are good candidates for RENAL TRANSPLANTATION.Hemodialysis is preferred to peritoneal dialysis. MY DOUBT: WONT THAT TRANSPLANTED KIDNEY BE AFFECTED BY SLE?????

67/m c/o brownish discoloration to urine. dysuria for 3 days NOT a diabetic/ hypertensive. kindly suggest the treatment

4 yr old male kid, with no history of pain in abdomen. currently on the medication of paracetamol and ofloxacin oral syrup. below is the urine he voided out now. any serious Dx.???

a 60 yrs old male patient. brought to the hospital with complaints of SOB since 2 days bp.180/100mmhg bl.urea63mg/DL.sr.creatinine.10.1mg/DL...RBs 180 mg/DL....wbc...17,000...ESR...100..hb%-6.5gms

37 yr old male, case of end stage renal disease on haemodialysis.under went nephrectomy for uncontrolled hypertension,c/o dyspnoea, orthopnoea since 4 days post sx. ur comments on chest x ray!!!