Systemic lupus erythematosus is an autoimmune multisystem disorder with a remitting and relapsing course. There is a strong female to male prepondance (9:1). The onset is usually in the 2nd/3rd decade of life, however it can occur at any age.
Type 2: Cytotoxic, Antibodies against cells
Type 3: Immune complex deposition in organs
Involves an array of bewildered antibodies:
Antinuclear antibody: Sensitive (+ve in 95% SLE patients)
Anti-dsDNA: Specific for SLE, can be used to monitor disease activity (high levels)
Anti-Sm antibody: Specific for SLE
Anti-phospholipid antibody
Monitoring SLE disease activity:
Serum complement: low C3 and C4, high C3 degradation product
ESR: high / do CRP to distinguish lupus flare from infection
Renal involvement is common and can exacerbate renal failure which can lead to death. WHO has classified into classes of lupus nephritis
Minimal Mesangial Lupus Glomerulonephritis
Light microscope: histologically normal
Electron microscope: mesangial deposits
Mesangial Proliferating Lupus Nephritis
Responds to corticosteroids
Focal Proliferative Lupus Nephritis
Responds to high dose corticosteroids
Mild microscopic haemturia and proteinuria
Renal failure is uncommon
Diffuse Proliferative Lupus Nephritis
Haematuria + moderate to severe proteinuria
Renal insufficiency / renal failure is common
Glomerular injury eventually gives rise to glomerulosclerosis
Membranous Lupus Nephritis
Severe proteinuria and nephritic syndrome
Microscopy shows widespread thickening of capillary wall
Advanced Sclerosing Lupus Nephritis
>90% of glomeruli sclerosed
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