Systemic lupus erythematosus (renal manifestations)

Last revised by Rohit Sharma on 8 Feb 2024

Citation, DOI, disclosures and article data

Citation:

Moore C, Sharma R, Murphy A, Systemic lupus erythematosus (renal manifestations). Reference article, Radiopaedia.org (Accessed on 03 May 2024) https://doi.org/10.53347/rID-183622

DOI:

https://doi.org/10.53347/rID-183622

Permalink:

https://radiopaedia.org/articles/183622

rID:

183622

Article created:

6 Feb 2024, Candace Makeda Moore

Disclosures:

At the time the article was created Candace Makeda Moore had no financial relationships to ineligible companies to disclose.

View Candace Makeda Moore's current disclosures

Last revised:

8 Feb 2024, Rohit Sharma ◉

Disclosures:

At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.

View Rohit Sharma's current disclosures

Revisions:

4 times, by 3 contributors - see full revision history and disclosures

Systems:

Urogenital

Tags:

cases

Synonyms:

Lupus nephritis

Renal manifestations of systemic lupus erythematosus include several conditions secondary to systemic lupus erythematosus (SLE) effecting the kidneys. While lupus nephritis drives kidney damage in many patients other entities considered by some but not all separate, such as lupus podocytopathy, are also associated with SLE ¹. Additionally, several systemic problems such as thromboembolic phenomenon or vasculitis may effects the kidneys in patients with SLE.

For a general overview and consideration of other system specific manifestations of SLE please refer to the article on systemic lupus erythematosus.

The vast majority of patients with SLE will develop will develop renal complications, and over half will develop lupus nephritis ^2,3. While the percentage of patients who eventually progress to end-stage kidney disease may vary depending upon population, large studies indicate that around 4% will eventually progress to this outcome ³.

Pediatric patients with SLE appear to be particularly adversely effected in terms of renal outcomes ⁴.

Clinical presentation

Most patients with SLE will at some point in the disease progression have abnormal urine on laboratory examination, whether due to hematuria, casts, proteinuria or elevated creatinine ^ref. Lupus nephritis varies in severity, and patients may be asymptomatic, or present with acute kidney injury or chronic kidney disease ⁵.

Pathology

The pathogenesis of all the renal manifestations of SLE is not completely clear, however, the consensus is that genetics play a role, and more proximally immune complex deposition plays an import role ⁶. Glomerular lesions are typically present, and play a prominent role in various classification schema ^ref.

Radiographic features

While there are radiographic signs of the kidney damage of SLE such as renal atrophy (which will be apparent if present in almost any modality), assessment of the severity of renal disease as well as classification is typically done with urine analysis and histopathology if there has been a tissue biopsy.

Treatment and prognosis

Biopsy should be considered in patients with significantly abnormal urinary biomarkers not attributable to causes other than lupus nephritis, as the presence of nephritis should often change the treatment course. Immunosuppression is the mainstay of treatment for lupus nephritis ⁵.