Renal-Limited “Lupus-Like” Nephritis: How Much of a Lupus

Maziad, Asmaa S.Abu; Torrealba, José; Seikaly, Mouin G.; Hassler, Jared; Hendricks, Allen R.

doi:10.1159/000475493

Cited by 924 publications

(5 citation statements)

References 26 publications

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“…Lupus nephritis encompasses a spectrum of glomerular, tubulointerstitial, and vascular changes occurring in patients with SLE. Despite its protean manifestations, some pathologic features of lupus nephritis are felt to be characteristic enough to allow authors to apply the term "lupus-like" to describe diverse entities including cases of apparently kidney-limited SLE, HIV-associated immune complex disease of the kidney, and even some cases of glomerulonephritis associated with HCV infection (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). However, the pathologic features used to label these cases as lupus-like are highly variable, reflecting a lack of formal criteria to diagnose lupus nephritis.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, nearly 5% of the nonlupus nephritis glomerulopathies fulfilled three of the five criteria for lupus nephritis. Some of these patients may have a forme fruste of SLE, may meet criteria for SLE in the future, and have been variably referred to as "lupus-like nephritis" or "full-house nephropathy" in the literature (11)(12)(13)(14)(15)(16)(17)(18)(19). Such cases are highly heterogeneous.…”

Section: Discussionmentioning

confidence: 99%

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Sensitivity and Specificity of Pathologic Findings to Diagnose Lupus Nephritis

Kudose¹,

Santoriello²,

Bomback

et al. 2019

CJASN

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Background and objectivesIn 2012, the Systemic Lupus International Collaborating Clinics proposed that lupus nephritis, in the presence of positive ANA or anti-dsDNA antibody, is sufficient to diagnose SLE. However, this “stand-alone” kidney biopsy criterion is problematic because the ISN/RPS classification does not specifically define lupus nephritis. We investigated the combination of pathologic features with optimal sensitivity and specificity for the diagnosis of lupus nephritis.Design, setting, participants, & measurementsThree hundred consecutive biopsies with lupus nephritis and 560 contemporaneous biopsies with nonlupus glomerulopathies were compared. Lupus nephritis was diagnosed if there was a clinical diagnosis of SLE and kidney biopsy revealed findings compatible with lupus nephritis. The control group consisted of consecutives biopsies showing diverse glomerulopathies from patients without SLE, including IgA nephropathy, membranous glomerulopathy, pauci-immune glomerulonephritis, membranoproliferative glomerulonephritis (excluding C3 GN), and infection-related glomerulonephritis. Sensitivity and specificity of individual pathologic features and combinations of features were computed.ResultsFive characteristic features of lupus nephritis were identified: “full-house” staining by immunofluorescence, intense C1q staining, extraglomerular deposits, combined subendothelial and subepithelial deposits, and endothelial tubuloreticular inclusions, each with sensitivity ranging from 0.68 to 0.80 and specificity from 0.8 to 0.96. The presence of at least two, three, or four of the five criteria had a sensitivity of 0.92, 0.8, and 0.66 for the diagnosis of lupus nephritis, and a specificity of 0.89, 0.95, and 0.98.ConclusionsIn conclusion, combinations of pathologic features can distinguish lupus nephritis from nonlupus glomerulopathies with high specificity and varying sensitivity. Even with stringent criteria, however, rare examples of nonlupus glomerulopathies may exhibit characteristic features of lupus nephritis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sensitivity and Specificity of Pathologic Findings to Diagnose Lupus Nephritis

Kudose¹,

Santoriello²,

Bomback

et al. 2019

CJASN

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“…Maziad, et al, 19 reported in 2017 the case of a 5year-old Hispanic boy with nephritis lupus-like. The clinical presentation was edema, proteinuria and rapidly progressive glomerulonephritis requiring hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical course of our patients coincides with that reported in the literature with variable evolution and prognosis. [5][6][7]9,18,19 One case did not achieve remission due to discontinuation of treatment, persisted with proteinuria and deterioration of renal function with current creatinine in 2.4 mg/dL two years after kidney biopsy. Only one case, a 24-year-old woman, eight years after kidney biopsy and on maintenance therapy with an adequate response, had seroconversion during her first pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Lupus-like membranous nephropathy. Is it lupus? Report of 5 cases in a reference hospital in Mexico

Ramírez-Gómez

Ruiz-Leija

Martínez-Galla

et al. 2021

Lupus

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Introduction: Lupus nephritis requires antinuclear antibodies as classification criteria. There is a group of patients with nephrotic syndrome and conclusive histopathological findings for lupus nephritis, without classification criteria for systemic lupus erythematosus (SLE) or extrarenal manifestations. These groups of patients have been described as “lupus-like” nephritis or “renal-limited lupus nephritis”. Methods: Renal biopsy with histopathological evaluation with “full-house” immune-reactants in patients with negative antinuclear antibodies. Results: We report four cases with nephrotic syndrome and one with hematuria-proteinuria syndrome: two with impaired glomerular filtration rate and three with preserved renal function; urinary sediment with hematuria without dysmorphia and without extrarenal manifestations for autoimmune disease, negative antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA); normal C3 and C4 complement levels. Renal biopsy in all cases was consistent for lupus nephritis class V. All patients received treatment as lupus nephritis protocol; only one case received induction with cyclophosphamide and methylprednisolone boluses, the rest received mycophenolic acid and prednisone as induction and maintenance. Two of the cases induced with mycophenolic acid relapsed, requiring cyclophosphamide for 6 months, achieving complete remission. All patients received renin-angiotensin-aldosterone system blockade and hydroxychloroquine. At follow-up, 4 cases still have negative antibodies and are without extrarenal manifestations for SLE classification criteria. The other case, during pregnancy several years after initial diagnosis, had preeclampsia with nephrotic proteinuria and a new determination of positive ANA and anti-dsDNA antibodies, complement levels below normal limits. Conclusion: The follow-up of patients with membranous glomerulopathy must be close; lupus like nephritis may be the first manifestation of the disease.

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“…Extrarenal signs and symptoms of systemic lupus erythematosus (SLE), as well as serologic lupus antibody testing, are typically absent. [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment of HIV-Associated Lupus-like Membranous Nephropathy with Tacrolimus: A Case Report and Review of the Literature

Kofotolios

Tsiakas

Skalioti

et al. 2023

Life

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Renal complications of HIV infection are common and histologically diverse. Besides HIV-associated nephropathy, which is the most well-defined glomerular disorder, immune-complex-mediated glomerulonephritis (HIVICK) is also encountered in the setting of HIV infection and may occasionally present with “lupus-like” features by light microscopy and immunofluorescence. Management of HIVICK remains controversial and mainly focuses on HIV viremia suppression with combined antiretroviral therapy. Immunosuppressive therapy may be used in order to mitigate the renal inflammation induced by the immune complex deposition. Data regarding the use of immunosuppressants in HIVICK are very limited, mostly including corticosteroids and mycophenolate acid analogues. Herein, we present the case of a 40-year-old HIV-infected Caucasian man with nephrotic syndrome, renal impairment, and a “lupus-like” membranous pattern in the kidney biopsy, who achieved a partial response of his proteinuria with a tacrolimus-based regimen in combination with antiretroviral therapy.

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Renal-Limited “Lupus-Like” Nephritis: How Much of a Lupus

Cited by 924 publications

References 26 publications

Sensitivity and Specificity of Pathologic Findings to Diagnose Lupus Nephritis

Sensitivity and Specificity of Pathologic Findings to Diagnose Lupus Nephritis

Lupus-like membranous nephropathy. Is it lupus? Report of 5 cases in a reference hospital in Mexico

Treatment of HIV-Associated Lupus-like Membranous Nephropathy with Tacrolimus: A Case Report and Review of the Literature

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