Systemic lupus Erythematosus and lupus nephritis
SLE is an autoimmune disease with systemic manifestations. It
affects 1/10,000 population. The incidence is higher in females than in
males (9 : 1). It affects caucasian more than black and occurs more in
adolescents than in elderly. Most probably the disease reflects an
exaggerated response to common environmental agents in a genetically
susceptible host.
Circulating and in-situ formation of DNA-anti-DNA immune
complexes are thought to be the main pathogenic mechanisms for SLE.
Complement deficiency may be a promoting factor. Not all SLE patients
will show clinically evident renal involvement. But, if kidney biopsies are
obtained and examined thoroughly, all patients will show glomerular
disease.
In clinical practice lupus nephritis is responsible for more than 5%
of patients presenting with glomerulonephritis. Sometimes renal
manifestations are the main presentation of SLE patient with minor
systemic disease.
Clinical Manifestations of Lupus Nephritis:
It is known that 50-90% of lupus patients will show
manifestation(s) of renal disease. Many of such patients may not show any
clinically apparent renal disease, but when subjected to kidney biopsy
glomerular lesions will be detected.
Clinical presentation of lupus nephritis patient may vary from
asymptomatic urine abnormality to rapidly progressive glomerulonephritis.
Furthermore, some patients show manifestations of tubulointerstitial
nephritis (e.g. RTA) or vasculitis.