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Diagnosis and classification of renal disease in systemic lupus erythematosus

Andrew S Bomback, MD, MPH
Gerald B Appel, MD
Section Editors
Richard J Glassock, MD, MACP
David S Pisetsky, MD, PhD
Deputy Editor
Albert Q Lam, MD


Renal involvement is common in systemic lupus erythematosus (SLE). An abnormal urinalysis with or without an elevated plasma creatinine concentration is present in a large proportion of patients at the time of diagnosis of lupus nephritis. The most frequently observed abnormality in patients with lupus nephritis is proteinuria [1].

Clinical findings underestimate the true frequency of renal involvement, as some patients may (rarely) have significant pathologic abnormalities without any clinical signs of renal involvement. (See 'Silent lupus nephritis' below.)

There are several types of renal disease in SLE (most commonly, immune complex-mediated glomerular disease), which are usually differentiated with a renal biopsy. In addition, renal diseases that are unrelated to lupus may be seen [2,3].

An overview of the epidemiology, pathogenesis, and classification of lupus nephritis will be presented here. The indications for renal biopsy and the approach to therapy in the different types of lupus nephritis are discussed separately. (See "Indications for renal biopsy in patients with lupus nephritis" and "Treatment and prognosis of diffuse or focal proliferative lupus nephritis" and "Clinical features and therapy of lupus membranous nephropathy".)


The pattern of glomerular injury seen in systemic lupus erythematosus (SLE) (and in other immune complex-mediated glomerular diseases) is primarily related to the site of formation of the immune deposits, which are primarily due to anti-double-stranded DNA antibodies (anti-dsDNA, or anti-DNA). These antibodies bind DNA in various forms, such as DNA in the form of nucleosomes, which consist of dsDNA wound around a core histone octamer [4].

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Literature review current through: Nov 2017. | This topic last updated: Mar 24, 2016.
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