Tuesday, October 23, 2012
Lupus Nephritis Clinical Presentation
Lupus nephritis is a serious complication of systemic lupus erythematosus (SLE; lupus) and is a major predictor of poor outcome. Most commonly, lupus nephritis develops early in the course of disease, but it can be a late complication as well (called delayed lupus nephritis [DLN]). Mortality is higher for lupus patients who develop nephritis than for those who do not.
Patients with active lupus nephritis often have other symptoms of active systemic lupus erythematosus (SLE), including fatigue, fever, rash, arthritis, serositis, or central nervous system (CNS) disease. These are more common with focal proliferative and diffuse proliferative lupus nephritis.
Some patients have asymptomatic lupus nephritis; however, during regular follow-up, laboratory abnormalities such as elevated serum creatinine levels, low albumin levels, or urinary protein or sediment suggests active lupus nephritis. This is more typical of mesangial or membranous lupus nephritis.
Symptoms related to active nephritis may include peripheral edema secondary to hypertension or hypoalbuminemia. Extreme peripheral edema is more common in persons with diffuse or membranous lupus nephritis, as these renal lesions are commonly associated with heavy proteinuria.
Other symptoms directly related to hypertension that are commonly associated with diffuse lupus nephritis include headache, dizziness, visual disturbances, and signs of cardiac decompensation.
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