What Are the Different Types of Lupus Nephritis Treatment?

Lupus nephritis refers to a disease of systemic lupus erythematosus (SLE) combined with immune damage of different pathological types of both kidneys, accompanied by obvious clinical manifestations of renal damage. Its pathogenesis is related to immune complex formation, immune cells and immune abnormalities. In addition to systemic manifestations of SLE, the clinical manifestations are mainly hematuria, proteinuria, and renal insufficiency. The pathological classification of lupus nephritis is of great value in judging disease activity and prognosis, and in formulating treatment plans. Treatment plans should be made according to the individuality of the disease.

Basic Information

English name: lupus nephritis, LN
Visiting department: Division of Rheumatology
Multiple groups: Young adults

Common causes: Related to the deposition of circulating immune complexes in the kidney, the direct role of autoantibodies, etc.
Common symptoms: Hematuria, proteinuria, renal insufficiency, etc.

Causes of Lupus Nephritis

SLE is a specific autoimmune disease involving multiple factors including heredity, sex hormones, environment, infection, drugs, and immune response. The interaction of various factors mentioned above causes the disorder of the body's immune system. The most important feature is the production of various autoantibodies such as anti-nuclear antibodies, which form immune complexes with antigens and are accompanied by immune abnormalities such as immune cells and cytokines. This is the common mechanism of multiple tissue and organ damage in SLE. The pathogenesis of lupus nephritis may be related to the following factors: the deposition of circulating immune complexes in the kidney; the formation of in situ immune complexes; the activation of local complements; the direct effects of autoantibodies;

Clinical manifestations of lupus nephritis

Whole body performance

Intermittent fever, palate erythema (butterfly erythema), discoid erythema, photosensitivity, oral ulcers, arthritis, serositis, neurological abnormalities (convulsions or psychosis).

2. Renal manifestations

Simple hematuria or proteinuria, hematuria, proteinuria with edema, backache or hypertension, ie nephritis-like manifestations; large amounts of proteinuria, hypoproteinemia, edema, ie nephrotic syndrome-like manifestations; hematuria, proteinuria with sharp renal function Decreased, showing the appearance of progressive nephritis; renal interstitial disease; chronic renal failure.

Lupus nephritis test

Routine urine test

May have varying degrees of urinary protein, microscopic hematuria, white blood cells, red blood cells, and cast urine.

2. Hemolytic anemia

The white blood cell count was less than 4.0 × 10 ⁹ / L, and the platelets were less than 100 × 10 ⁹ / L.

3. Immunological examination

A variety of serum autoantibodies were positive, -globulin was significantly increased, blood circulation immune complexes were positive, and hypocomplementemia.

4. Severe active lupus nephritis

Accompanied by reversible creatinine clearance (Ccr) decreased to varying degrees, blood urea nitrogen and creatinine increased; end-stage lupus nephritis Ccr decreased significantly and blood creatinine and urea nitrogen significantly increased.

5. Imaging examination

B-ultrasounds show enlarged kidneys indicating acute disease; shrinking kidneys indicate chronic renal failure.

6. Kidney biopsy

Not only helps to confirm the diagnosis of lupus nephritis, but also to understand the type of pathology, disease activity, degree of kidney damage, and decide on treatment options.

Diagnosis of lupus nephritis

For patients with a clear diagnosis of SLE, if the above manifestations of renal involvement are present, lupus nephritis can be diagnosed.

Pathological classification

The pathological classification of lupus nephritis of the World Health Organization includes a total of 6 types, from type I to type VI, and the prognosis is from good to poor. Type I: Normal or minor lesion type; Type II: Mesangial proliferative lupus nephritis; Type III: focal proliferative lupus nephritis; Type IV: diffuse proliferative lupus nephritis; Type V: membranous lupus nephritis; Type VI: sclerosing lupus nephritis.

2. Index of renal pathological activity in lupus nephritis

(1) Proliferative changes of glomerular cells;

(2) cellulose necrosis and nucleus lysis;

(3) Cellular crescents;

(4) Platinum ear phenomenon and vitreous thrombosis;

(5) Glomerular neutrophil infiltration;

(6) Renal interstitial monocyte infiltration.

3. Chronicity index

(1) Glomerulosclerosis;

(2) Fibrous crescent;

(3) Renal tubular atrophy;

(4) Renal interstitial fibrosis.

Lupus nephritis treatment

Treatment principle

SLE is still an unexplained disease. The main purpose of treatment is to control LN activity, protect renal function, and delay the progress of renal tissue fibrosis.

2. Mild SLE and Lupus Nephritis

If the target organ function is normal or stable, use non-steroidal anti-inflammatory drugs or anti-malarial drugs as appropriate. Medium- and low-dose glucocorticoids (such as prednisone 20-40mg / d) can be used for a short period of time, and immunosuppression can be added if necessary Agent.

3. SLE and lupus nephritis

Patients with significant damage to important target organs, patients with persistent glomerulonephritis, rapid glomerulonephritis, and nephrotic syndrome should be given standard hormone therapy (prednisone 1mg / kg / d) and immunosuppressive therapy. Patients with acute life-threatening severe lupus should be treated with hormone shock (methylprednisolone 0.5-1.0g / d). When the above method is not effective or the condition is severe, plasma exchange therapy can be considered. With acute severe renal insufficiency, severe hypervolemia, and heart failure, emergency dialysis should be performed to make it through the dangerous period.

4. End-stage treatment

End-stage lupus nephritis is treated as chronic renal failure.