Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 22-14: Nephritic Spectrum Glomerular Diseases + Key Features Download Section PDF Listen +++ ++ Renal involvement is common in systemic lupus erythematosus (SLE), occurring in 35–90% of SLE patients + Clinical Findings Download Section PDF Listen +++ ++ History and physical examination consistent with SLE Urinalysis: hematuria and proteinuria + Diagnosis Download Section PDF Listen +++ ++ Kidney biopsy shows one of six histologic patterns Class I: minimal mesangial nephritis Class II: mesangial proliferative Class III: focal (< 50% of glomeruli affected with capillary involvement) proliferative Class IV: diffuse (> 50% of glomeruli affected with capillary involvement) proliferative Class V: membranous nephropathy Class VI: advanced sclerosis without residual disease activity Class III and IV, the most severe forms of proliferative lupus nephritis, are further classified as active or chronic, and global or segmental, which confers additional prognostic value + Treatment Download Section PDF Listen +++ ++ No treatment required for classes I and II Corticosteroids should be considered for those with class II lesions with nephrotic-range proteinuria Aggressive immunosuppressive therapy for extensive class III lesions and all class IV lesions Immunosuppressive therapy for class V lupus nephritis is indicated if superimposed proliferative lesions exist Class VI lesions should not be treated Corticosteroids: methylprednisolone, 1 g once daily for 3 days intravenously, followed by prednisone, 1 mg/kg once daily orally with subsequent taper for 6–12 months Cyclophosphamide induction regimens Vary, but usually involve monthly intravenous pulse doses (500–1000 mg/m2) for 6 months Induction is followed by daily oral mycophenolate mofetil or azathioprine maintenance therapy Cyclosporine or tacrolimus may be considered, but relapse is high upon discontinuation Mycophenolate mofetil Typically given at 2–3 g orally daily, then tapered to 1–2 g/day for maintenance Has a more favorable side-effect profile than does cyclophosphamide Should be favored when preservation of fertility is a consideration Rituximab Was used in addition to corticosteroids and mycophenolate mofetil for class III/IV LN induction therapy in a recent clinical trial but did not show significant renal improvement over placebo at 1 year Remission rates with induction vary from 80% for partial remission to 50–60% for full remission Relapse is common and rates of disease flare are higher in those who do not experience complete remission Monitoring dsDNA antibodies; C3, C4, and CH50; urinary protein; and urine sediment activity can be useful during treatment Patients with SLE undergoing kidney transplants can have recurrent kidney disease, although rates are relatively low