Lupus nephritis

These patients essentially have normal renal function and urinalysis. This is rare to see as such patients would not have a renal biopsy.

Mesangial hypercellularity is seen on biopsy, with very few subendothelial deposits on electron microscopy. Microscopic haematuria or proteinuria will be seen, but there will very rarely be any other features. This does not generally need any specific treatment.

Sclerosis of less than 50% of glomeruli seen on light microscopy.

Proteinuria and haematuria are seen, and some patients will have clinical features of nephrotic syndrome, hypertension and deranged renal function.

This is the most common and severe type seen.

On light microscopy, more than 50% of glomeruli are affected. Patients will have nephrotic syndrome, hypertension and deranged renal function on blood tests. Other markers of SLE activity will also be present, such as hypocomplementemia and elevated anti-dsDNA.

This requires aggressive treatment with corticosteroids and immunosuppression.

Glomerular walls are diffusely thickened on light microscopy, with subepithelial immune deposits on immune fluorescence and electron microscopy.

Patients present with nephrotic syndrome, similar to primary membranous nephritis. Some patients may have no other systemic features of SLE and no positive autoantibodies.

This is a late stage of lupus nephritis, with sclerosis of over 90% of glomeruli. There is no active glomerulonephritis.

Investigations show progressively worsening renal dysfunction with ongoing protein leak.

Immunosuppression is not helpful as the immune-mediated injury has already occurred.