26th June 2023

Systemic Lupus Erythematosus

Renal disease occurs in at least 1/3rd of patients with systemic lupus erythematosus (SLE), and of these, a quarter reach end stage renal failure within ten years. SLE is a multi-system disorder affecting most body systems. SLE can also cause a clinical picture of glomerulonephritis.

The most common presentation is of a sub-acute nephritic disease with haematuria, hypertension, and renal impairment. Almost any histological pattern of glomerular disease can be seen in SLE on renal biopsy, including stains positive for IgG, IgM, IgA and complement proteins. The clinical presentation ranges from an indolent and slowing progressive nephrotic syndrome to a florid rapidly progressive glomerulonephritis requiring renal replacement therapy. Immunofluorescence staining shows substantial deposits within the glomerulus.

The classification of lupus nephritis (LN) is as follows:

Class I – minimal mesangial deposition (asymptomatic)
Class II – mesangial proliferative LN (mild renal disease)
Class III – focal LN, involving <50% glomeruli (haematuria and proteinuria)
Class IV – diffuse LN, involving >50% glomeruli (most common and severe form of LN)
Class V – membranous LN (good prognosis)
Class VI – advanced sclerosing LN >90% sclerosed glomeruli (progressive CKD)

Treatment is with high dose steroids and intravenous cyclophosphamide. Prognosis is best for patients with type I, II and V.