Materiały źródłowe

• #1 Lupus Nephritis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/l/lupus-nephritis.html

  Lupus nephritis is an inflammation of the kidney caused by the rheumatic condition systemic lupus erythematosus (SLE). […] An estimated one-third of people with lupus will develop nephritis that requires medical evaluation and treatment. […] Because symptoms can vary from person to person and even within the same person from day to day, diagnosing lupus nephritis can be challenging. […] A urinalysis is the simplest and most common test used to find out if a person has lupus nephritis. […] If blood and urine studies suggest lupus nephritis, a biopsy is done to confirm the diagnosis. […] Thanks to major advances in the understand and treatment of lupus nephritis, more than 80% of people with lupus nephritis will live a normal life span.

• #2 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Lupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE) a chronic autoimmune disease that causes inflammation and damage to multiple organ systems, with the kidneys as a primary target. […] Early detection of SLE through monitoring renal function, including serum creatinine levels, urine protein-to-creatinine ratios, and urinalysis, is essential for effectively managing the condition. […] Renal biopsy is used to determine the disease stage, but treatment may be initiated empirically if a biopsy is not feasible. […] Monitoring kidney function in patients with SLE is crucial, as early detection and management of renal impairment can significantly improve outcomes. […] Histological evidence of lupus nephritis is present in most SLE patients, even when clinical signs of renal disease are not apparent.

• #3 Lupus Nephritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25699

  Lupus nephritis typically develops 3 to 5 years after the onset of SLE. Histological evidence of lupus nephritis is present in most SLE patients, even when clinical signs of renal disease are not apparent. […] Monitoring for the development of lupus nephritis involves serial assessments of creatinine levels, urine protein-to-creatinine ratio, and urinalysis. These tests help detect increases in serum creatinine and the presence of proteinuria, which is commonly observed in lupus nephritis. […] Renal biopsy is fundamental to accurately diagnosing lupus nephritis. A biopsy is usually performed in cases of a urine protein-to-creatinine ratio exceeding 500 mg/24 h, persistent renal dysfunction, or active urinary sediment. […] The current standardized classification system for lupus nephritis is based on recommendations from the World Health Organization (WHO) and the International Society of Nephrology/Renal Pathology Society. This classification system categorizes lupus nephritis based on glomerular morphological changes observed under light microscopy, immune deposits identified through immunofluorescence, and findings from electron microscopy.

• #4 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Lupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE) a chronic autoimmune disease that causes inflammation and damage to multiple organ systems, with the kidneys as a primary target. […] Early detection of SLE through monitoring renal function, including serum creatinine levels, urine protein-to-creatinine ratios, and urinalysis, is essential for effectively managing the condition. […] Renal biopsy is used to determine the disease stage, but treatment may be initiated empirically if a biopsy is not feasible. […] Monitoring kidney function in patients with SLE is crucial, as early detection and management of renal impairment can significantly improve outcomes. […] Histological evidence of lupus nephritis is present in most SLE patients, even when clinical signs of renal disease are not apparent.

• #5 Lupus & Kidney Disease (Lupus Nephritis) – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/lupus-nephritis

  Lupus nephritis is diagnosed through urine and blood tests and a kidney biopsy. […] Your health care professional uses a urine sample to look for blood and protein in your urine. […] A kidney biopsy can confirm a diagnosis of lupus nephritis. […] The American College of Rheumatology recommends biopsies for people with signs of active lupus nephritis who have not yet been treated. […] Early diagnosis and prompt treatment may help protect your kidneys.

• #6 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification

  Lupus nephritis: Diagnosis and classification […] Kidney 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 (LN). […] The diagnosis of LN is ideally confirmed by a kidney biopsy. A kidney biopsy is important to define the nature of kidney involvement, exclude other causes of kidney injury, and determine the histopathologic subtype of LN. Biopsies are also important to assess disease activity and chronicity. […] A kidney biopsy should be performed in most patients with SLE who have clinical or laboratory evidence of kidney involvement (eg, abnormal proteinuria, active urine sediment, elevated serum creatinine and/or decreased glomerular filtration rate [GFR]) to establish the correct diagnosis and determine the histologic subtype of LN.

• #7 Diagnosing Lupus Nephritis > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/lupus-nephritis

  Pathologists use advanced imaging studies to evaluate kidney tissue samples. […] For determining if lupus is affecting the kidneys, causing inflammation. […] The next step is may be a kidney biopsy. […] The kidney biopsy is the gold standard for the diagnosis of lupus nephritis, Dr. Moeckel says. […] If lupus nephritis is suspected, doctors will order a kidney biopsy, which can be performed on an outpatient basis. […] The clinician can look at a patients symptoms and laboratory tests and say, I think this patient has lupus nephritis, but the kidney biopsy, which is the definitive test, is done in the pathology department, Dr. Moeckel says. […] The pathologists in Yale Medicines renal pathology lab use advanced techniques and technology, including immunofluorescence and electron microscopy (highly specialized and powerful types of microscopes), to study the kidney tissue samples of patients with lupus nephritis. […] The findings are then given a designated type and activity grade that reflects how aggressively the disease has attacked the kidney.

• #8 Diagnosis and Treatment

  https://www.allinforlupusnephritis.com/diagnosis-and-treatment

  People with lupus are at high risk for developing lupus nephritis. This makes routine testing vital to uncovering problems that can lead to more serious outcomes, such as kidney failure or cardiovascular complications. […] There are 3 tests commonly used to help diagnose lupus nephritis: […] Urine tests are the most frequent tests you’ll receive. They’re vital to detect any problems with the way your kidneys are functioning. Your physician will collect a urine sample and check for levels of protein (also referred to as proteinuria) and blood (hematuria) in the urine. Your protein levels should stay below 0.5 grams per day. […] It’s recommended that people living with lupus get a urine test every 3 months, while those with active lupus nephritis are tested as often as monthly. […] Blood tests measure creatinine, a waste product that results from the normal breakdown of muscles. The amount of creatinine in your blood is used to estimate your glomerular filtration rate (eGFR), which is used to determine how well the kidneys are filtering blood.

• #9 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Monitoring for the development of lupus nephritis involves serial assessments of creatinine levels, urine protein-to-creatinine ratio, and urinalysis. […] Renal biopsy is fundamental to accurately diagnosing lupus nephritis. […] A biopsy is usually performed in cases of a urine protein-to-creatinine ratio exceeding 500 mg/24 h, persistent renal dysfunction, or active urinary sediment. […] The current standardized classification system for lupus nephritis is based on recommendations from the World Health Organization (WHO) and the International Society of Nephrology/Renal Pathology Society. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse.

• #10 Lupus Nephritis | Diagnosis & Disease Information

  https://www.renalandurologynews.com/ddi/lupus-nephritis/

  Lupus nephritis is one of the more common and severe manifestations of systemic lupus erythematosus (SLE). This article covers the causes, risk factors, symptoms, diagnosis, and treatment of lupus nephritis. […] Testing for kidney involvement in patients with SLE is indicated as regular surveillance and at the time of SLE diagnosis or when a disease flare is suspected. […] According to the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines, the following tests can be used to assess for kidney involvement in SLE: Estimated glomerular filtration rate (eGFR); Serology (anti-dsDNA and complement); Serum creatinine; Spot protein-creatinine ratio; and Urinalysis (dipstick and sediment). […] If there is evidence of decreasing GFR or if proteinuria is 500 mg/d or greater, a kidney biopsy should be considered. […] A biopsy allows for the classification of lupus nephritis based on the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification.

• #11 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Monitoring for the development of lupus nephritis involves serial assessments of creatinine levels, urine protein-to-creatinine ratio, and urinalysis. […] Renal biopsy is fundamental to accurately diagnosing lupus nephritis. […] A biopsy is usually performed in cases of a urine protein-to-creatinine ratio exceeding 500 mg/24 h, persistent renal dysfunction, or active urinary sediment. […] The current standardized classification system for lupus nephritis is based on recommendations from the World Health Organization (WHO) and the International Society of Nephrology/Renal Pathology Society. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse.

• #12 Diagnosis and Treatment

  https://www.allinforlupusnephritis.com/diagnosis-and-treatment

  People with lupus are at high risk for developing lupus nephritis. This makes routine testing vital to uncovering problems that can lead to more serious outcomes, such as kidney failure or cardiovascular complications. […] There are 3 tests commonly used to help diagnose lupus nephritis: […] Urine tests are the most frequent tests you’ll receive. They’re vital to detect any problems with the way your kidneys are functioning. Your physician will collect a urine sample and check for levels of protein (also referred to as proteinuria) and blood (hematuria) in the urine. Your protein levels should stay below 0.5 grams per day. […] It’s recommended that people living with lupus get a urine test every 3 months, while those with active lupus nephritis are tested as often as monthly. […] Blood tests measure creatinine, a waste product that results from the normal breakdown of muscles. The amount of creatinine in your blood is used to estimate your glomerular filtration rate (eGFR), which is used to determine how well the kidneys are filtering blood.

• #13 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  Lupus nephritis: Diagnosis and classification […] Kidney 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 (LN). […] An overview of the epidemiology, pathogenesis, diagnosis, and classification of LN will be presented here. The approach to therapy in the different types of LN is discussed separately: […] The presence of lupus nephritis (LN) should be suspected in patients with known systemic lupus erythematosus (SLE) who develop an active urinary sediment with persistent hematuria (five or more red blood cells, most of which are dysmorphic, per high-power field) and/or cellular casts, proteinuria, and/or an elevated serum creatinine (or decrease in estimated glomerular filtration rate [eGFR]). Elevated anti-double-stranded-DNA (anti-dsDNA) titers and low complement (C3 and C4) levels often indicate active SLE, particularly LN, although the utility of serological assessment differs among patients.

• #14 Lupus Nephritis Biomarkers: A Critical Review

  https://www.mdpi.com/1422-0067/25/2/805

  AutoAbs have emerged as invaluable biomarkers that provide insights into disease activity and progression. Several autoAbs have been found to be associated with LN. […] Anti-dsDNA antibodies and C1q are frequently used as LN biomarkers and have been endorsed by guidelines for disease monitoring. […] The presence of antibodies against C1q is associated with LN, with high specificity (92%) and sensitivity (56%). […] The measurement of autoAb levels could potentially enhance the early detection, monitoring, and management of LN. […] In addition to autoAbs, various serum proteins have emerged as potential LN biomarkers. These include cytokines, chemokines, and adhesion molecules. […] Several cytokines have been examined as potential biomarkers to assess the activity, severity, and renal involvement of SLE.

• #15 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  Lupus nephritis: Diagnosis and classification […] Kidney 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 (LN). […] An overview of the epidemiology, pathogenesis, diagnosis, and classification of LN will be presented here. The approach to therapy in the different types of LN is discussed separately: […] The presence of lupus nephritis (LN) should be suspected in patients with known systemic lupus erythematosus (SLE) who develop an active urinary sediment with persistent hematuria (five or more red blood cells, most of which are dysmorphic, per high-power field) and/or cellular casts, proteinuria, and/or an elevated serum creatinine (or decrease in estimated glomerular filtration rate [eGFR]). Elevated anti-double-stranded-DNA (anti-dsDNA) titers and low complement (C3 and C4) levels often indicate active SLE, particularly LN, although the utility of serological assessment differs among patients.

• #16 Lupus Nephritis Workup: Approach Considerations, Laboratory Tests for Kidney Function in SLE, Laboratory Tests for SLE Disease Activity

  https://emedicine.medscape.com/article/330369-workup

  Clinically relevant lupus nephritis is associated with a 30% decrease in creatinine clearance, proteinuria of greater than 1000 mg/d, and/or renal biopsy findings indicating active lupus nephritis. […] Anti-C1q antibodies are associated with lupus nephritis; higher titers correlate with active renal disease. […] Kidney biopsy may be useful in patients with recurrent episodes of nephritis, depending on the clinical circumstances. […] A good rule is to perform a kidney biopsy if the findings will potentially alter patient management. […] The experience of pathologists in reading lupus nephritis biopsy specimens varies considerably. […] The classification of lupus nephritis was revised by the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) in 2003 and is based on light microscopy, immunofluorescence, and electron microscopy findings from kidney biopsy specimens. […] In addition to the pathologic classification, activity and chronicity indices are scored pathologically and predict the renal prognosis that is, the progression of renal disease.

• #17 Lupus Blood Tests : Johns Hopkins Lupus Center

  https://www.hopkinslupus.org/lupus-tests/lupus-blood-tests/

  The presence of anti-dsDNA antibodies often suggests more serious lupus, such as lupus nephritis (kidney lupus). […] The anti-Sm antibody is usually measured by one of four methods: ELISA, counterimmunoelectrophoreses (CIE), immunodiffusion, or hemagglutination. […] Anti-Ro/SSA and Anti-La/SSB are antibodies found mostly in people with systemic lupus (30-40%) and primary Sjogrens syndrome. […] Antibodies to histones, proteins that help to lend structure to DNA, are usually found in people with drug-induced lupus (DIL), but they can also be found in people with systemic lupus. […] A serum complement test measures the levels of proteins consumed during the inflammatory process.

• #18 Disease Week: Lupus Nephritis | Arkana Laboratories

  https://www.arkanalabs.com/disease-week-lupus-nephritis/

  Double-stranded DNA antibody titers help predict lupus nephritis flares if they are present. Double-stranded DNA antibodies are often seen in patients with lupus nephritis and correlate with disease activity. […] An increase in dsDNA antibody titer is associated with an increased risk of renal flare and with hypocomplementemia (with an inverse correlation with C3). Antibody titers drop in response to treatment, with a 50% decrease in dsDNA antibody titer reducing renal flare rate 52-53% in two treatment cohorts. […] The International Society of Nephrology (ISN) and Renal Pathology Society (RPS) created a lupus nephritis classification system consisting of 6 classes of disease based on morphologic findings on kidney biopsy. […] The classes are based on the distribution of immune deposits and the proportions of glomeruli affected. This classification is VERY glomerulocentric.

• #19 Lupus Nephritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330369-overview

  Lupus nephritis is staged according to the classification revised by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS) in 2003. […] Key points of American College of Rheumatology guidelines for managing lupus nephritis are as follows: Patients with clinical evidence of active, previously untreated lupus nephritis should have a kidney biopsy to classify the disease according to ISN/RPS criteria. […] All patients with lupus nephritis should receive background therapy with hydroxychloroquine, unless contraindicated. […] Glucocorticoids plus either cyclophosphamide intravenously or mycophenolate mofetil orally should be administered to patients with class III/IV disease; patients with class I/II nephritis do not require immunosuppressive therapy. […] Patients with class V lupus nephritis are generally treated with prednisone for 1-3 months, followed by tapering for 1-2 years if a response occurs. If no response occurs, the drug is discontinued.

• #20 Renal Biopsy: Impact on Diagnosis, Prognosis, and Clinical Decision Making in Lupus Nephritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/renal-biopsy-impact-on-diagnosis-prognosis-and-clinical-decision-making-in-lupus-nephritis/

  Renal damage from lupus nephritis (LN) is a significant risk for patients with systemic lupus erythematosus (SLE). Early and accurate diagnosis of LN and the initiation of appropriate therapy are critical to minimize the risk for progression to end-stage renal disease. […] The American College of Rheumatology (ACR) guidelines for the management of LN recommend renal biopsy (unless strongly contraindicated) for all patients with clinical evidence of active LN that has been previously untreated. Renal biopsy is generally recommended in patients with increasing serum creatinine levels without compelling alternative causes (such as sepsis, hypovolemia, or medication). […] In fact, renal biopsy has been shown to be an important tool to support classification and definitive diagnosis of LN histopathologic subtype, assess prognosis, and tailor treatment according to the specific glomerular involvement. […] Because of these challenges, disagreement persists regarding the appropriate role of renal biopsy in the management and identification of predictors of short- and long-term outcomes.

• #21 Lupus Nephritis Workup: Approach Considerations, Laboratory Tests for Kidney Function in SLE, Laboratory Tests for SLE Disease Activity

  https://emedicine.medscape.com/article/330369-workup

  Evaluating kidney function in patients with systemic lupus erythematosus (SLE) to detect any kidney involvement early is important because early detection and treatment can significantly improve renal outcome. […] Kidney biopsy should be considered in any patient with SLE who has clinical or laboratory evidence of active nephritis, especially upon the first episode of nephritis. […] Lupus nephritis is staged according to the classification revised by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS) in 2013. This classification is based on light microscopy, immunofluorescence, and electron microscopy findings from kidney biopsy specimens. […] In an international study, Smith and colleagues reported that a panel of novel urinary biomarkers can accurately identify active lupus nephritis in children.

• #22 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Monitoring for the development of lupus nephritis involves serial assessments of creatinine levels, urine protein-to-creatinine ratio, and urinalysis. […] Renal biopsy is fundamental to accurately diagnosing lupus nephritis. […] A biopsy is usually performed in cases of a urine protein-to-creatinine ratio exceeding 500 mg/24 h, persistent renal dysfunction, or active urinary sediment. […] The current standardized classification system for lupus nephritis is based on recommendations from the World Health Organization (WHO) and the International Society of Nephrology/Renal Pathology Society. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse.

• #23 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Lupus nephritis is one of the more common and severe manifestations of systemic lupus erythematosus (SLE). This article covers the causes, risk factors, symptoms, diagnosis, and treatment of lupus nephritis. […] Testing for kidney involvement in patients with SLE is indicated as regular surveillance and at the time of SLE diagnosis or when a disease flare is suspected. […] According to the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines, the following tests can be used to assess for kidney involvement in SLE: Estimated glomerular filtration rate (eGFR); Serology (anti-dsDNA and complement); Serum creatinine; Spot protein-creatinine ratio; and Urinalysis (dipstick and sediment). […] If there is evidence of decreasing GFR or if proteinuria is 500 mg/d or greater, a kidney biopsy should be considered.

• #24 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  Establishing the diagnosis—The diagnosis of LN is ideally confirmed by a kidney biopsy. A kidney biopsy is important to define the nature of kidney involvement, exclude other causes of kidney injury, and determine the histopathologic subtype of LN. Biopsies are also important to assess disease activity and chronicity. […] A kidney biopsy should be performed in most patients with SLE who have clinical or laboratory evidence of kidney involvement (eg, abnormal proteinuria, active urine sediment, elevated serum creatinine and/or decreased glomerular filtration rate [GFR]) to establish the correct diagnosis and determine the histologic subtype of LN. […] Determining the nature and class of LN is important for the following reasons: […] Treatment is guided by the histologic subtype (ie, the International Society of Nephrology/Renal Pathology Society [ISN/RPS] class, the degree of activity and chronicity) and by complicating lesions such as interstitial nephritis and thrombotic microangiopathy.

• #25 About Lupus Nephritis

  https://www.allinforlupusnephritis.com/about-lupus-nephritis

  Lupus nephritis is not as uncommon as you may think, and can lead to serious complications if left untreated. […] Lupus nephritis is a rare disease but it’s one of the most common and serious complications of lupus, affecting about 50% of people living with it. […] It’s critically important to catch lupus nephritis early. Early diagnosis and treatment may help prevent irreversible kidney damage and other serious complications. […] Early diagnosis and treatment can help prevent irreversible kidney damage and other serious complications. […] Symptoms of lupus nephritis can be subtle, inconsistent, or hard to recognize—that’s why frequent testing is so important. […] Routine testing by a doctor is key to helping you stay ahead of potential long-term damage and complications. […] Clinical signs that require testing include: High levels of protein in the urine (known as proteinuria) that show up in a clinical laboratory urine test. […] A rheumatologist or nephrologist will use the results of a kidney biopsy to figure out how lupus nephritis has affected the kidneys. This information can also help doctors decide on an appropriate treatment plan.

• #26 Diagnosing Lupus Nephritis > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/lupus-nephritis

  Pathologists use advanced imaging studies to evaluate kidney tissue samples. […] For determining if lupus is affecting the kidneys, causing inflammation. […] The next step is may be a kidney biopsy. […] The kidney biopsy is the gold standard for the diagnosis of lupus nephritis, Dr. Moeckel says. […] If lupus nephritis is suspected, doctors will order a kidney biopsy, which can be performed on an outpatient basis. […] The clinician can look at a patients symptoms and laboratory tests and say, I think this patient has lupus nephritis, but the kidney biopsy, which is the definitive test, is done in the pathology department, Dr. Moeckel says. […] The pathologists in Yale Medicines renal pathology lab use advanced techniques and technology, including immunofluorescence and electron microscopy (highly specialized and powerful types of microscopes), to study the kidney tissue samples of patients with lupus nephritis. […] The findings are then given a designated type and activity grade that reflects how aggressively the disease has attacked the kidney.

• #27 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  Glomerular deposits that stain dominantly for IgG and contain co-deposits of immunoglobulin A (IgA), immunoglobulin M (IgM), C3, and C1q, the so-called „full house” immunofluorescence pattern. […] Glomerular deposits simultaneously seen in the mesangial, subendothelial, and subepithelial locations. […] Timing of initial biopsy—Ideally, a kidney biopsy is performed promptly (ie, within days to weeks) in patients who have an appropriate indication. Prompt diagnosis after the onset of LN and subsequent initiation of appropriate therapy are associated with improved outcomes, regardless of the histologic class. […] The potential magnitude of the increase in risk with delayed kidney biopsy was illustrated in a study of 91 patients with LN who were followed for a median of six years. Patients who had clinically recognized kidney disease for six or more months prior to biopsy had a much higher rate of end-stage kidney disease (ESKD; 47 versus 14 per 1000 patient-years for those who had an earlier biopsy; hazard ratio 9.3, 95% CI 1.8-47.0).

• #28 Diagnosing Lupus Nephritis > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/lupus-nephritis

  Pathologists use advanced imaging studies to evaluate kidney tissue samples. […] For determining if lupus is affecting the kidneys, causing inflammation. […] The next step is may be a kidney biopsy. […] The kidney biopsy is the gold standard for the diagnosis of lupus nephritis, Dr. Moeckel says. […] If lupus nephritis is suspected, doctors will order a kidney biopsy, which can be performed on an outpatient basis. […] The clinician can look at a patients symptoms and laboratory tests and say, I think this patient has lupus nephritis, but the kidney biopsy, which is the definitive test, is done in the pathology department, Dr. Moeckel says. […] The pathologists in Yale Medicines renal pathology lab use advanced techniques and technology, including immunofluorescence and electron microscopy (highly specialized and powerful types of microscopes), to study the kidney tissue samples of patients with lupus nephritis. […] The findings are then given a designated type and activity grade that reflects how aggressively the disease has attacked the kidney.

• #29 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://www.revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  Lupus nephritis affects over half of all patients with systemic lupus erythematosus (SLE). This condition increases mortality and morbidity rates among patients due to, among other reasons, the risk of chronic kidney disease with the need for renal replacement therapy in approximately 25% of cases. Lupus nephritis is diagnosed in our health area in women in their thirties and is the primary cause of systemic disease with secondary renal involvement. […] Although marked advances have been made in recent decades in the diagnosis and treatment of this condition, there are several aspects that require collaboration between different specialists. […] Lupus nephritis should be classified according to the histological classes defined in 2003 by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS) (NG). The histological analysis requires optical microscope and immunofluorescence techniques, and an electron microscope analysis is also recommended (NG).

• #30 Pathology Outlines – Systemic lupus erythematosus

  https://www.pathologyoutlines.com/topic/kidneysle.html

  Lupus nephritis (LN) is an immune complex mediated renal injury encountered in systemic lupus erythematosus (SLE) […] Diagnosis is made in patients with a clinical diagnosis of systemic lupus erythematosus […] Light, immunofluorescence and electron microscopy are required for the correct classification of lupus nephritis […] Full house immunofluorescence staining, significant C1q positivity, extraglomerular immunostaining and the finding of tubuloreticular inclusions by electron microscopy establish the lupus etiology of nephritis […] Patients with known lupus who develop persistent hematuria, proteinuria, active urinary sediment, elevated serum creatinine / glomerular filtration rate decrease, low complement, elevated anti-dsDNA […] Kidney biopsy establishes the diagnosis and guides treatment

• #31 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  Biopsy may also identify entities other than LN. Some patients with SLE and nephrotic-range proteinuria will have a lupus podocytopathy without major immune complex deposition but with effaced foot processes as seen in minimal change disease. Others with kidney disease may have a thrombotic microangiopathy or predominant tubulointerstitial involvement rather than major glomerular involvement. […] The clinical presentation may not accurately reflect the severity of the histologic findings. As an example, infrequently, proliferative lupus may be present even if the patient has minimal proteinuria and normal serum creatinine. […] Characteristic histopathologic findings—The histopathology of LN can be quite varied, and at times, LN may be confused with other immune complex-mediated glomerulonephritides. However, some histopathologic features are highly characteristic of LN. These include:

• #32 Lupus nephritis – Wikipedia

  https://en.wikipedia.org/wiki/Lupus_nephritis

  Lupus nephritis is an inflammation of the kidneys caused by systemic lupus erythematosus (SLE) and childhood-onset systemic lupus erythematosus which is a more severe form of SLE that develops in children up to 18 years old; both are autoimmune diseases. […] The diagnosis of lupus nephritis depends on blood tests, urinalysis, X-rays, ultrasound scans of the kidneys, and a kidney biopsy. […] On urinalysis, a nephritic picture is found and red blood cell casts, red blood cells and proteinuria is found. […] A tubuloreticular inclusion within capillary endothelial cells is also characteristic of lupus nephritis and can be seen under an electron microscope in all stages. […] The World Health Organization and the International Society of Nephrology/Renal Pathology Society has divided lupus nephritis into six classes based on the biopsy.

• #33 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  When to repeat the biopsy—The indications for a repeat biopsy include the emergence of an active sediment in someone with previously quiescent disease, a new elevation in serum creatinine, and/or worsening of proteinuria despite treatment. […] The utility of repeat biopsy depends in part upon the histologic diagnosis obtained on the initial biopsy. Among patients with lupus membranous nephropathy, a repeat biopsy is warranted for those who develop an active sediment or a rising serum creatinine since these findings suggest transformation to a class III or IV lesion, which usually requires different treatment. […] Histopathologic classification of LN—Based upon clinicopathologic correlations derived from kidney biopsy, a lupus nephritis (LN) classification system was developed by a group of kidney pathologists, nephrologists, and rheumatologists in 2004 (the ISN/RPS classification) and revised in 2018. The revised ISN/RPS classification system divides glomerular disorders associated with SLE into six different patterns (or classes) based upon kidney biopsy histopathology. LN activity and chronicity indices have also been proposed to provide more granularity to the diagnosis of active and chronic lesions. […] Although various serologic and urine markers have been examined as potential noninvasive determinants of histologic class, no serum or urine marker of disease activity provides the degree of information that is gained by histopathology. Thus, classification of LN is determined by kidney biopsy.

• #34 Lupus Nephritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330369-overview

  Lupus nephritis is staged according to the classification revised by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS) in 2003. […] Key points of American College of Rheumatology guidelines for managing lupus nephritis are as follows: Patients with clinical evidence of active, previously untreated lupus nephritis should have a kidney biopsy to classify the disease according to ISN/RPS criteria. […] All patients with lupus nephritis should receive background therapy with hydroxychloroquine, unless contraindicated. […] Glucocorticoids plus either cyclophosphamide intravenously or mycophenolate mofetil orally should be administered to patients with class III/IV disease; patients with class I/II nephritis do not require immunosuppressive therapy. […] Patients with class V lupus nephritis are generally treated with prednisone for 1-3 months, followed by tapering for 1-2 years if a response occurs. If no response occurs, the drug is discontinued.

• #35 What is lupus nephritis? | Lupus Foundation of America

  https://www.lupus.org/resources/what-is-lupus-nephritis

  Getting tested and treated as soon as possible is extremely important. Testing used in evaluating and diagnosing kidney issues include a urine test or urinalysis, blood test, and kidney biopsy. Your doctor or a special doctor called a nephrologist can help you find the right treatment if you have lupus nephritis. […] Doctors perform a kidney biopsy when deciding how to categorize your lupus nephritis. This is done by using a thin needle (usually inserted through the back) to remove a small piece of the kidney and then looking at the tissue with a microscope. […] Your lupus nephritis will be classified into one of six different categories, based on how much inflammation or damage is seen underneath the microscope. Its important to know that your lupus nephritis classification may change over time, from one class to another.

• #36 6 Classes of Lupus Nephritis: Diagnosis and Treatment | MyLupusTeam

  https://www.mylupusteam.com/resources/lupus-nephritis-stages

  Lupus nephritis is separated into six classes or stages. Doctors use the classes of lupus nephritis to describe how much damage has occurred in a persons kidneys. […] Doctors usually diagnose classes of lupus nephritis by looking at kidney tissue under a microscope. This requires a kidney biopsy also known as a renal biopsy which involves removing a small piece of tissue from the kidney. […] Your symptoms, along with an analysis of your blood and urine, can help a doctor diagnose your lupus nephritis stage. Proteinuria (protein loss in urine) is a common warning sign that may lead a doctor to do more tests, like a kidney biopsy. […] There are six classes of lupus nephritis. The classes are defined by the amount of damage to the kidneys and renal function (how well the kidney works). […] A person is diagnosed with class 4 (class IV) lupus nephritis when more than 50 percent of their glomeruli have been affected. […] People with stage 6 lupus nephritis will likely need dialysis or a kidney transplant. At this stage, most of the kidney tissue is damaged, so treatment focuses on supportive care, which means managing symptoms and improving quality of life.

• #37 Pathology Outlines – Systemic lupus erythematosus

  https://www.pathologyoutlines.com/topic/kidneysle.html

  Ultrasound, CT, MRI and nuclear medicine have only a minor role in the diagnosis of lupus nephritis […] LN classes I and II: excellent renal prognosis […] LN class III: favorable prognosis with no histological progression and renal function deterioration; a small percent progressing to class IV and severe renal damage […] LN class IV: worst renal prognosis, with class IV-S possibly faring worse than IV-G (controversial) […] Treatment is guided by the LN class, activity and chronicity indices […] LN classes I and II require blockade of the renin-angiotensin-aldosterone system (RAAS) in all patients with hypertension or proteinuria […] LN class III, class IV and class V require immunosuppressive therapy […] Immunosuppressive therapy consists of initial and subsequent phases […] Initial (induction) therapy typically consists of cyclophosphamide or mycophenolate (MMF) and glucocorticoid […] Subsequent (maintenance) therapy consists of MMF or azathioprine

• #38 Lupus nephritis – Wikipedia

  https://en.wikipedia.org/wiki/Lupus_nephritis

  This classification was defined in 1982 and revised in 1995. […] Class IV disease (Diffuse proliferative nephritis) is both the most severe, and the most common subtype. […] Drug regimens prescribed for lupus nephritis include mycophenolate mofetil (MMF), intravenous cyclophosphamide with corticosteroids, and the immune suppressant azathioprine with corticosteroids. […] MMF and cyclophosphamide with corticosteroids are equally effective in achieving remission of the disease, however the results of a systematic review found that immunosuppressive drugs were better than corticosteroids for renal outcomes. […] In those who have SLE, concomitant lupus nephritis is associated with a worse overall prognosis. […] 10-30% of people with lupus nephritis progress to kidney failure requiring dialysis, with the 5 year mortality rate of lupus nephritis being 5-25%.

• #39 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  The number and type of immunosuppressive drugs used, their dosage, and duration of treatment must all be decided upon based on the clinical manifestations of the patient, his/her renal function, the histological characteristics observed in the renal biopsy, and the evolution towards a complete or partial response. […] In patients with class III or IV lupus nephritis, we recommend treating with glucocorticosteroids accompanied by one of the following therapeutic options: Cyclophosphamide, Mycophenolate mofetil, or enteric-coated mycophenolate sodium. […] In patients with class V lupus nephritis, we recommend initial treatment with prednisone up to 1mg/kg/day, accompanied by one of the following treatment options: Cyclophosphamide, Calcineurin inhibitors, Mycophenolate mofetil, or Azathioprine. […] The diagnosis of class VI lupus nephritis should essentially be clinical, and a renal biopsy should not be routinely indicated. […] The diagnosis of the nephropathy in this phase of the disease is based on clinical evidence.

• #40 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Monitoring for the development of lupus nephritis involves serial assessments of creatinine levels, urine protein-to-creatinine ratio, and urinalysis. […] Renal biopsy is fundamental to accurately diagnosing lupus nephritis. […] A biopsy is usually performed in cases of a urine protein-to-creatinine ratio exceeding 500 mg/24 h, persistent renal dysfunction, or active urinary sediment. […] The current standardized classification system for lupus nephritis is based on recommendations from the World Health Organization (WHO) and the International Society of Nephrology/Renal Pathology Society. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse.

• #41 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  When to repeat the biopsy—The indications for a repeat biopsy include the emergence of an active sediment in someone with previously quiescent disease, a new elevation in serum creatinine, and/or worsening of proteinuria despite treatment. […] The utility of repeat biopsy depends in part upon the histologic diagnosis obtained on the initial biopsy. Among patients with lupus membranous nephropathy, a repeat biopsy is warranted for those who develop an active sediment or a rising serum creatinine since these findings suggest transformation to a class III or IV lesion, which usually requires different treatment. […] Histopathologic classification of LN—Based upon clinicopathologic correlations derived from kidney biopsy, a lupus nephritis (LN) classification system was developed by a group of kidney pathologists, nephrologists, and rheumatologists in 2004 (the ISN/RPS classification) and revised in 2018. The revised ISN/RPS classification system divides glomerular disorders associated with SLE into six different patterns (or classes) based upon kidney biopsy histopathology. LN activity and chronicity indices have also been proposed to provide more granularity to the diagnosis of active and chronic lesions. […] Although various serologic and urine markers have been examined as potential noninvasive determinants of histologic class, no serum or urine marker of disease activity provides the degree of information that is gained by histopathology. Thus, classification of LN is determined by kidney biopsy.

• #42 Lupus Nephritis Workup: Approach Considerations, Laboratory Tests for Kidney Function in SLE, Laboratory Tests for SLE Disease Activity

  https://emedicine.medscape.com/article/330369-workup

  Clinically relevant lupus nephritis is associated with a 30% decrease in creatinine clearance, proteinuria of greater than 1000 mg/d, and/or renal biopsy findings indicating active lupus nephritis. […] Anti-C1q antibodies are associated with lupus nephritis; higher titers correlate with active renal disease. […] Kidney biopsy may be useful in patients with recurrent episodes of nephritis, depending on the clinical circumstances. […] A good rule is to perform a kidney biopsy if the findings will potentially alter patient management. […] The experience of pathologists in reading lupus nephritis biopsy specimens varies considerably. […] The classification of lupus nephritis was revised by the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) in 2003 and is based on light microscopy, immunofluorescence, and electron microscopy findings from kidney biopsy specimens. […] In addition to the pathologic classification, activity and chronicity indices are scored pathologically and predict the renal prognosis that is, the progression of renal disease.

• #43 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  When to repeat the biopsy—The indications for a repeat biopsy include the emergence of an active sediment in someone with previously quiescent disease, a new elevation in serum creatinine, and/or worsening of proteinuria despite treatment. […] The utility of repeat biopsy depends in part upon the histologic diagnosis obtained on the initial biopsy. Among patients with lupus membranous nephropathy, a repeat biopsy is warranted for those who develop an active sediment or a rising serum creatinine since these findings suggest transformation to a class III or IV lesion, which usually requires different treatment. […] Histopathologic classification of LN—Based upon clinicopathologic correlations derived from kidney biopsy, a lupus nephritis (LN) classification system was developed by a group of kidney pathologists, nephrologists, and rheumatologists in 2004 (the ISN/RPS classification) and revised in 2018. The revised ISN/RPS classification system divides glomerular disorders associated with SLE into six different patterns (or classes) based upon kidney biopsy histopathology. LN activity and chronicity indices have also been proposed to provide more granularity to the diagnosis of active and chronic lesions. […] Although various serologic and urine markers have been examined as potential noninvasive determinants of histologic class, no serum or urine marker of disease activity provides the degree of information that is gained by histopathology. Thus, classification of LN is determined by kidney biopsy.

• #44 Lupus Nephritis Workup: Approach Considerations, Laboratory Tests for Kidney Function in SLE, Laboratory Tests for SLE Disease Activity

  https://emedicine.medscape.com/article/330369-workup

  Clinically relevant lupus nephritis is associated with a 30% decrease in creatinine clearance, proteinuria of greater than 1000 mg/d, and/or renal biopsy findings indicating active lupus nephritis. […] Anti-C1q antibodies are associated with lupus nephritis; higher titers correlate with active renal disease. […] Kidney biopsy may be useful in patients with recurrent episodes of nephritis, depending on the clinical circumstances. […] A good rule is to perform a kidney biopsy if the findings will potentially alter patient management. […] The experience of pathologists in reading lupus nephritis biopsy specimens varies considerably. […] The classification of lupus nephritis was revised by the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) in 2003 and is based on light microscopy, immunofluorescence, and electron microscopy findings from kidney biopsy specimens. […] In addition to the pathologic classification, activity and chronicity indices are scored pathologically and predict the renal prognosis that is, the progression of renal disease.

• #45 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  When to repeat the biopsy—The indications for a repeat biopsy include the emergence of an active sediment in someone with previously quiescent disease, a new elevation in serum creatinine, and/or worsening of proteinuria despite treatment. […] The utility of repeat biopsy depends in part upon the histologic diagnosis obtained on the initial biopsy. Among patients with lupus membranous nephropathy, a repeat biopsy is warranted for those who develop an active sediment or a rising serum creatinine since these findings suggest transformation to a class III or IV lesion, which usually requires different treatment. […] Histopathologic classification of LN—Based upon clinicopathologic correlations derived from kidney biopsy, a lupus nephritis (LN) classification system was developed by a group of kidney pathologists, nephrologists, and rheumatologists in 2004 (the ISN/RPS classification) and revised in 2018. The revised ISN/RPS classification system divides glomerular disorders associated with SLE into six different patterns (or classes) based upon kidney biopsy histopathology. LN activity and chronicity indices have also been proposed to provide more granularity to the diagnosis of active and chronic lesions. […] Although various serologic and urine markers have been examined as potential noninvasive determinants of histologic class, no serum or urine marker of disease activity provides the degree of information that is gained by histopathology. Thus, classification of LN is determined by kidney biopsy.

• #46 Lupus Nephritis Urine Test May Aid Diagnosis, Guide Treatment – Renal and Urology News

  https://www.renalandurologynews.com/news/lupus-nephritis-urine-test-may-aid-diagnosis-guide-treatment/

  Improvement in results on a noninvasive urinary biomarker panel at 3 months among patients with lupus nephritis predicted a clinical response at 1 year. […] A noninvasive urinary biomarker panel predicts lupus nephritis activity and response better than proteinuria, and, if further validated, may aid diagnosis and gauge treatment response, investigators reported at the ACR Convergence 2024 meeting in Washington, DC. […] Upon further validation, this biomarker panel could aid in the diagnosis of lupus nephritis and longitudinally guide treatment decisions in lupus nephritis.

• #47 Lupus Nephritis Biomarkers: A Critical Review

  https://www.mdpi.com/1422-0067/25/2/805

  Lupus nephritis (LN), a major complication in individuals diagnosed with systemic lupus erythematosus, substantially increases morbidity and mortality. […] Therefore, timely detection of LN is vital for initiating prompt therapeutic interventions and improving patient outcomes. Biomarkers have emerged as valuable tools for LN detection and monitoring; however, the complex role of these biomarkers in LN pathogenesis remains unclear. Renal biopsy remains the gold standard for the identification of the histological phenotypes of LN and guides disease management. […] In recent years, remarkable progress has been made in understanding the pathophysiology of LN, leading to the identification of novel biomarkers related to cellular and inflammatory mechanisms. […] Currently, the scientific community is building momentum to incorporate more comprehensive approaches, including proteomics and metabolomics, to develop reliable diagnostic and prognostic markers. Here, we review various published approaches regarding the development of biomarkers for LN.

• #48 Immune-Related Urine Biomarkers for the Diagnosis of Lupus Nephritis

  https://www.mdpi.com/1422-0067/22/13/7143

  Currently, laboratory markers for LN such as proteinuria, creatinine clearance, urine protein/creatinine ratio, anti-double strand DNA autoantibodies (anti-dsDNA), and low plasma complement levels (mostly C3 and C4) have been applied in monitoring LN activity in daily clinical routines. Nonetheless, these clinical parameters lack sensitivity and specificity to reflect the real-time renal immunopathological activity and chronic tissue damage. Therefore, novel biomarkers able to discriminate lupus renal activity and its severity, predict renal flares, and monitor treatment response and disease progress are clearly necessary. […] In contrast to other biological sample sources, such as serum or tissue, urine sampling is non-invasive, allowing frequent monitoring, and can be self-collected, transported, and stored easily. Furthermore, urinary biomarkers seem to be more promising than serum markers in the study of LN, given that they derive from tissues of the urinary system, so that they can reflect its current pathological status. Thus, urine is an attractive source for finding potential biomarkers in the study of LN.

• #49 Immune-Related Urine Biomarkers for the Diagnosis of Lupus Nephritis

  https://www.mdpi.com/1422-0067/22/13/7143

  Many immune-related mediators or antibodies may be excreted into urine from the inflamed and damaged kidneys of LN patients. […] Evaluation of urine biomarkers in clinical care may predict development of renal flares and determine therapeutic treatment. Here, we summarize the main immune-related urinary biomarkers that have been described as potential non-invasive biomarkers of LN. […] In summary, although there are very few studies reporting the clinical significance of urine autoantibodies, the analysis of their distinct specificities in urine and serum has the potential to become a useful tool for the diagnosis and monitoring of the renal disease activity in SLE patients. Nevertheless, this should be confirmed in larger and serial sampling studies. […] The complement is part of the innate immune system and is one of the main effector mechanisms of antibody-mediated immunity.

• #50 Lupus Nephritis Biomarkers: A Critical Review

  https://www.mdpi.com/1422-0067/25/2/805

  AutoAbs have emerged as invaluable biomarkers that provide insights into disease activity and progression. Several autoAbs have been found to be associated with LN. […] Anti-dsDNA antibodies and C1q are frequently used as LN biomarkers and have been endorsed by guidelines for disease monitoring. […] The presence of antibodies against C1q is associated with LN, with high specificity (92%) and sensitivity (56%). […] The measurement of autoAb levels could potentially enhance the early detection, monitoring, and management of LN. […] In addition to autoAbs, various serum proteins have emerged as potential LN biomarkers. These include cytokines, chemokines, and adhesion molecules. […] Several cytokines have been examined as potential biomarkers to assess the activity, severity, and renal involvement of SLE.

• #51 Lupus Nephritis Biomarkers: A Critical Review

  https://www.mdpi.com/1422-0067/25/2/805

  Urine MCP-1 (uMCP-1) levels were found to have a sensitivity of 89% and a specificity of 63% in differentiating active LN from inactive disease. […] Several urine proteins have emerged as promising tools for the diagnosis and ongoing monitoring of LN. […] Urine levels of transferrin and ceruloplasmin are elevated in patients with LN compared to those in individuals without LN. […] The complexity of LN pathogenesis poses challenges for the development of biomarkers for monitoring disease activity in response to treatment. […] Although tools that integrate multiple proteins, or other molecules, may have a greater value as biomarkers, the same limitations may apply.

• #52

  https://esmed.org/MRA/mra/article/view/6217

  Lupus nephritis is one of the most common severe organ manifestations of systemic lupus erythematosus (SLE). […] The clinical manifestations of lupus nephritis are variable and screening all SLE patients for lupus nephritis is imperative. […] Periodic screening of lupus nephritis in patients with SLE is imperative for early detection. Urinalysis and urine protein-to-creatinine ratio are useful screening tests. […] Renal biopsy remains the gold standard for diagnosis of lupus nephritis. […] Traditional serum biomarkers used to monitor lupus nephritis disease activity and flares include anti-double-stranded DNA antibodies and complement components 3 and 4. […] New biomarkers for lupus nephritis include anti-C1q and type 1 interferon regulatory genes, urinary monocyte chemoattractant protein 1, neutrophil gelatinase-associated lipocalin, tumor necrosis factor-like inducer of apoptosis, and vascular cell adhesion molecule 1.

• #53 Early Diagnosis and Monitoring of Lupus Nephritis – On Your Smartphone – University of Houston

  https://uh.edu/news-events/stories/2023/february-2023/02012023-monintoring-lupus-nephritis-smartphone.php

  A team of researchers at the University of Houston is reporting the success of their new method for the early diagnosis and monitoring of lupus nephritis at home. […] The home test with results read on a smartphone is meant to eventually replace the gold standard for diagnosis of active lupus nephritis, an invasive kidney biopsy, with its attendant morbidity which cannot be serially repeated. […] Urinary ALCAM (uALCAM) has shown high diagnostic accuracy for renal pathology activity in active lupus nephritis, reports Chandra Mohan, Hugh Roy and Lillie Cranz Cullen Endowed Professor of biomedical engineering, and one of the nations leading lupus researchers, in Frontiers in Immunology. […] This test had 86% accuracy for distinguishing active lupus nephritis from all other lupus patients.

• #54 Early Diagnosis and Monitoring of Lupus Nephritis – On Your Smartphone – University of Houston

  https://uh.edu/news-events/stories/2023/february-2023/02012023-monintoring-lupus-nephritis-smartphone.php

  Periodic monitoring of uALCAM using this easy-to-use LFA test by the patient at home could potentially accelerate early detection of renal involvement or disease flares in lupus patients, and hence reduce morbidity and mortality, said Willson. […] A point-of-care testing platforms importance rests on its potential to empower patients to monitor their health status with convenience, thus allowing for early diagnosis and monitoring of disease progression. […] In this work, the team used nanophosphor-based lateral flow immunoassays to demonstrate promise in facilitating home-based smartphone-enabled monitoring of disease activity in LN.

• #55 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  The responses must be evaluated according to the criteria for complete and partial responses. […] Recurrences in patients that have reached a good response to treatment should be evaluated for the appearance of proteinuria, increased creatinine levels, changes in urinary sediments, and, in general, the presence of immunological activity. […] The treatment of the most severe histological classes of lupus nephritis (classes III and IV) and class V is divided into two phases. […] The first phase, or induction of response, has the objective of producing early remission of the renal flare and to avoid progression towards chronicity. […] The second phase, or maintenance, has the objective of avoiding the development of renal flares during the evolution of the disease, and to maintain the improvements achieved during the induction phase.

• #56 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://www.revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  Justification Lupus nephritis should be classified according to the results from a renal biopsy. Normal clinical and laboratory analyses cannot predict the histological findings in a high percentage of cases. The histopathological diagnosis plays a leading role in establishing a prognosis and treatment. […] A renal biopsy is mandatory in patients with SLE and tests results indicative of renal involvement, such as increased creatinine, reduced glomerular filtration rate, proteinuria, haematuria, and active urinary sediments. […] A renal biopsy provides essential information for a) identifying the ISN/RPS class; b) establishing a prognosis, and c) planning treatment. […] The responses must be evaluated according to the criteria for complete and partial responses (NG). Responses are based on the evolution of creatinine, proteinuria, and urinary sediment values as compared to baseline values (NG).

• #57 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://www.revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  Recurrences in patients that have reached a good response to treatment should be evaluated for the appearance of proteinuria, increased creatinine levels, changes in urinary sediments, and, in general, the presence of immunological activity (NG). […] There is no standard definition for the patterns of response to treatment, although all are based upon the values observed in basic laboratory variables. […] The treatment of the most severe histological classes of lupus nephritis (classes III and IV) and class V is divided into two phases. […] The first phase, or induction of response, has the objective of producing early remission of the renal flare and to avoid progression towards chronicity. […] The second phase, or maintenance, has the objective of avoiding the development of renal flares during the evolution of the disease, and to maintain the improvements achieved during the induction phase.

• #58 Diagnosis and treatment of lupus nephritis flares—an update | Nature Reviews Nephrology

  https://www.nature.com/articles/nrneph.2012.220

  Relapses or flares of systemic lupus erythematosus (SLE) are frequent and observed in 27-66% of patients. […] A renal flare is indicated by an increase in proteinuria and/or serum creatinine concentration, abnormal urine sediment or a reduction in creatinine clearance rate as a result of active disease. […] Current induction treatment protocols achieve remission in the majority of patients with lupus nephritis; however, few studies focus on treatment interventions for renal flares in these patients. […] The available data, however, suggest that remission can be induced again in a substantial percentage of patients experiencing a lupus nephritis flare. […] Lupus nephritis flares are independently associated with an increased risk of deterioration in renal function; prevention of renal flares might, therefore, also decrease long-term morbidity and mortality.

• #59 Diagnosis and treatment of lupus nephritis flares—an update | Nature Reviews Nephrology

  https://www.nature.com/articles/nrneph.2012.220

  Appropriate immunosuppressive maintenance therapy might lead to a decrease in the occurrence of renal and extrarenal flares in patients with SLE, and monitoring for the early detection and treatment of renal flares could improve their outcomes. […] Renal flares are associated with impaired renal prognosis and increased cumulative exposure of patients to drug toxic effects. […] A nephritic flare is defined as an increase or recurrence of urinary sediment with or without increased proteinuria, and is usually associated with a decline in renal function. […] Reappearance of urinary casts and increased titres of antibodies to double-stranded DNA can predict renal flares. […] Whether monitoring of novel urinary or serum biomarkers can be used to predict lupus nephritis flares remains to be proven in prospective clinical trials. […] Prolonging the duration of maintenance therapy and careful clinical monitoring seem to decrease the incidence and severity of renal flares.

• #60 Diagnosis and treatment of lupus nephritis flares—an update | Nature Reviews Nephrology

  https://www.nature.com/articles/nrneph.2012.220

  Appropriate immunosuppressive maintenance therapy might lead to a decrease in the occurrence of renal and extrarenal flares in patients with SLE, and monitoring for the early detection and treatment of renal flares could improve their outcomes. […] Renal flares are associated with impaired renal prognosis and increased cumulative exposure of patients to drug toxic effects. […] A nephritic flare is defined as an increase or recurrence of urinary sediment with or without increased proteinuria, and is usually associated with a decline in renal function. […] Reappearance of urinary casts and increased titres of antibodies to double-stranded DNA can predict renal flares. […] Whether monitoring of novel urinary or serum biomarkers can be used to predict lupus nephritis flares remains to be proven in prospective clinical trials. […] Prolonging the duration of maintenance therapy and careful clinical monitoring seem to decrease the incidence and severity of renal flares.

• #61 About Lupus nephritis :: ZyVersa Therapeutics, Inc.

  https://www.zyversa.com/pipeline/about-lupus-nephritis

  Lupus nephritis is considered an Orphan disease, with around 80,000 100,000 patients in U.S, and 1 million worldwide. It is one of the most serious manifestations of systemic lupus erythematosus (SLE), occurring in 50 60% of patients, typically within 5 years of diagnosis. Nephritis is evident in most SLE patients biopsies, including those with no symptoms of kidney disease. […] The goal of therapy is to prevent progressive loss of kidney function, and ideally to normalize function. Therapy differs depending on the pathologic lesion, as it is important to treat extrarenal manifestations and other variables that may affect the kidneys. All patients receive background therapy of hydroxychloroquine, unless contraindicated. There are no renal-specific drugs approved for lupus nephritis. Treatment of kidney manifestations of SLE is similar to that of other kidney diseases, with ACE inhibitors and ARBs used to control hypertension, and corticosteroids as the mainstay for treating proteinuria, followed by immunosuppressive agents in non-responding patients. Patients with end-stage renal disease are unlikely to respond to aggressive therapy and require dialysis or kidney transplant. […] There is a significant unmet need for effective lupus nephritis-specific treatments that can delay disease progression, prevent end-stage renal disease, and improve patients quality of life.

• #62 Lupus Nephritis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/l/lupus-nephritis.html

  Lupus nephritis is an inflammation of the kidney caused by the rheumatic condition systemic lupus erythematosus (SLE). […] An estimated one-third of people with lupus will develop nephritis that requires medical evaluation and treatment. […] Because symptoms can vary from person to person and even within the same person from day to day, diagnosing lupus nephritis can be challenging. […] A urinalysis is the simplest and most common test used to find out if a person has lupus nephritis. […] If blood and urine studies suggest lupus nephritis, a biopsy is done to confirm the diagnosis. […] Thanks to major advances in the understand and treatment of lupus nephritis, more than 80% of people with lupus nephritis will live a normal life span.

• #63 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  Lupus nephritis affects over half of all patients with systemic lupus erythematosus (SLE). This condition increases mortality and morbidity rates among patients due to, among other reasons, the risk of chronic kidney disease with the need for renal replacement therapy in approximately 25% of cases. […] Lupus nephritis is diagnosed in our health area in women in their thirties and is the primary cause of systemic disease with secondary renal involvement. […] Although marked advances have been made in recent decades in the diagnosis and treatment of this condition, there are several aspects that require collaboration between different specialists. […] Lupus nephritis should be classified according to the histological classes defined in 2003 by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS).

• #64 II Brazilian Society of Rheumatology consensus for lupus nephritis diagnosis and treatment | Advances in Rheumatology | Full Text

  https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-024-00386-8

  All patients diagnosed with SLE, even if asymptomatic, should undergo creatinine and urinalysis tests to assess renal involvement. […] Kidney biopsy is considered the gold standard for diagnosing LN, establishing histological class (glomerulonephritis classes I to VI), evaluating parameters of activity (graded from 0-24) and chronicity (graded from 1-12) and guiding treatment according to previous published guidelines. […] However, accessibility to kidney biopsy is limited in Brazil and the use of clinical and laboratorial parameters remains the mainstay for diagnosis in most regions of our country. […] The presence of anti-C1q, anti-dsDNA, and complement consumption increases the risk of LN (OR 14.9; 95% CI 5.8-38.4). […] The consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil.

• #65 Lupus Nephritis Biomarkers: A Critical Review

  https://www.mdpi.com/1422-0067/25/2/805

  Lupus nephritis (LN), a major complication in individuals diagnosed with systemic lupus erythematosus, substantially increases morbidity and mortality. […] Therefore, timely detection of LN is vital for initiating prompt therapeutic interventions and improving patient outcomes. Biomarkers have emerged as valuable tools for LN detection and monitoring; however, the complex role of these biomarkers in LN pathogenesis remains unclear. Renal biopsy remains the gold standard for the identification of the histological phenotypes of LN and guides disease management. […] In recent years, remarkable progress has been made in understanding the pathophysiology of LN, leading to the identification of novel biomarkers related to cellular and inflammatory mechanisms. […] Currently, the scientific community is building momentum to incorporate more comprehensive approaches, including proteomics and metabolomics, to develop reliable diagnostic and prognostic markers. Here, we review various published approaches regarding the development of biomarkers for LN.

• #66 Lupus Nephritis | Disease Week | Arkana Laboratories

  https://www.arkanalabs.com/disease-week-lupus-nephritis-summary/

  New SLE diagnostic criteria increase sensitivity for lupus nephritis diagnosis, and novel biomarkers could prove helpful to compensate for reduced specificity. Under the new criteria established by the Systemic Lupus International Collaborating Clinic as a joint effort from the American College of Rheumatology and European League Against Rheumatism, a diagnosis of lupus nephritis can now be made with a positive antinuclear antibody and class III or IV lupus nephritis alone. […] There is a need for development and validation for serum and urine biomarkers to predict disease flare and response to therapy.

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