Skip to main content

Systemic Lupus Erythematosus, Antiphospholipid Syndrome and the Kidney

  • Chapter
  • First Online:
Practical Nephrology

Abstract

Kidney involvement in systemic lupus erythematosus (SLE) is common and is a major contributor to disease morbidity and mortality. At presentation, up to 50 % of patients with SLE will have clinical evidence of renal involvement – abnormal renal function and haematuria with or without proteinuria. During follow-up renal involvement will be evident in >60 %, with an even greater representation among children and young adults.

†Deceased

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Berden JH. Lupus nephritis. Kidney Int. 1997;52:538–58.

    Article  CAS  PubMed  Google Scholar 

  2. Austin HA, Illei GG. Membranous lupus nephritis. Lupus. 2005;14:65–71.

    Article  CAS  PubMed  Google Scholar 

  3. Pirani CL, Olesnicky L. Role of electronmicroscopy in the classification of lupus nephritis. Am J Kidney Dis. 1982;2:150–63.

    CAS  PubMed  Google Scholar 

  4. Tsumagari T, Fukumoto S, Kinjo M, Tanaka K. Incidence and significance of intrarenal vasculopathies in patients with systemic lupus erythematosus. Hum Pathol. 1985;16:43–9.

    Article  CAS  PubMed  Google Scholar 

  5. Banfi G, Bertani T, Boeri V, et al. Renal vascular lesions as a marker of poor prognosis in patients with lupus nephritis. Gruppo Italiano per lo Studio Della Nefrite Lupica (GISNEL). Am J Kidney Dis. 1991;18:240–8.

    CAS  PubMed  Google Scholar 

  6. Grishman E, Venkataseshan VS. Vascular lesions in lupus nephritis. Mod Pathol. 1988;1:235–41.

    CAS  PubMed  Google Scholar 

  7. Cameron JS. Lupus nephritis. J Am Soc Nephrol. 1999;10:413–24.

    CAS  PubMed  Google Scholar 

  8. Markowitz GS, D’Agati VD. Classification of lupus nephritis. Curr Opin Nephrol Hypertens. 2009;18:220–5.

    Article  CAS  PubMed  Google Scholar 

  9. Weening JJ, D’Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. 2004;15:241–50.

    Article  PubMed  Google Scholar 

  10. Dube GK, Markowitz GS, Radhakrishnan J, Appel GB, D’Agati VD. Minimal change disease in systemic lupus erythematosus. Clin Nephrol. 2002;57:120–6.

    Article  CAS  PubMed  Google Scholar 

  11. Kraft SW, Schwartz MM, Korbet SM, Lewis EJ. Glomerular podocytopathy in patients with systemic lupus erythematosus. J Am Soc Nephrol. 2005;16:175–9.

    Article  PubMed  Google Scholar 

  12. Han TS, Schwartz MM, Lewis EJ. Association of glomerular podocytopathy and nephrotic proteinuria in mesangial lupus nephritis. Lupus. 2006;15:71–5.

    Article  CAS  PubMed  Google Scholar 

  13. Illei GG, Austin HA, Crane M, et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Ann Intern Med. 2001;135:248–57.

    Article  CAS  PubMed  Google Scholar 

  14. Houssiau FA, Vasconcelos C, D’Cruz D, et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum. 2002;46:2121–31.

    Article  CAS  PubMed  Google Scholar 

  15. Houssiau FA, Vasconcelos C, D’Cruz D, et al. The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose and high-dose intravenous cyclophosphamide. Ann Rheum Dis. 2010;69:61–4.

    Article  CAS  PubMed  Google Scholar 

  16. Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group. N Engl J Med. 2000;343:1156–62.

    Article  CAS  PubMed  Google Scholar 

  17. Chan TM, Tse KC, Tang CS, Mok MY, Li FK. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol. 2005;16:1076–84.

    Article  CAS  PubMed  Google Scholar 

  18. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med. 2005;353:2219–28.

    Article  CAS  PubMed  Google Scholar 

  19. Walsh M, James M, Jayne D, Tonelli M, Manns BJ, Hemmelgarn BR. Mycophenolate mofetil for induction therapy of lupus nephritis: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2007;2:968–75.

    Article  CAS  PubMed  Google Scholar 

  20. Appel GB, Contreras G, Dooley MA, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol. 2009;20:1103–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Induction and maintenance therapy for lupus nephritis: a systematic review and meta-analysis. Lupus. 2010;19:703–10.

    Article  CAS  PubMed  Google Scholar 

  22. Grootscholten C, Ligtenberg G, Hagen EC, et al. Azathioprine/methylprednisolone versus cyclophosphamide in proliferative lupus nephritis. A randomized controlled trial. Kidney Int. 2006;70:732–42.

    Article  CAS  PubMed  Google Scholar 

  23. Lu TY, Ng KP, Cambridge G, et al. A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at University College London Hospital: the first fifty patients. Arthritis Rheum. 2009;61:482–7.

    Article  PubMed  Google Scholar 

  24. Melander C, Sallee M, Trolliet P, et al. Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome. Clin J Am Soc Nephrol. 2009;4:579–87.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Merrill JT, Neuwelt CM, Wallace DJ, et al. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 2010;62:222–33.

    Article  CAS  PubMed  Google Scholar 

  26. Rovin BH, Furie R, Latinis K, et al. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study. Arthritis Rheum. 2012;64:1215–26.

    Article  CAS  PubMed  Google Scholar 

  27. Flanc RS, Roberts MA, Strippoli GF, Chadban SJ, Kerr PG, Atkins RC. Treatment of diffuse proliferative lupus nephritis: a meta-analysis of randomized controlled trials. Am J Kidney Dis. 2004;43:197–208.

    Article  CAS  PubMed  Google Scholar 

  28. Zhu B, Chen N, Lin Y, et al. Mycophenolate mofetil in induction and maintenance therapy of severe lupus nephritis: a meta-analysis of randomized controlled trials. Nephrol Dial Transplant. 2007;22:1933–42.

    Article  CAS  PubMed  Google Scholar 

  29. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med. 2004;350:971–80.

    Article  CAS  PubMed  Google Scholar 

  30. Contreras G, Tozman E, Nahar N, Metz D. Maintenance therapies for proliferative lupus nephritis: mycophenolate mofetil, azathioprine and intravenous cyclophosphamide. Lupus. 2005;14 Suppl 1:s33–8.

    Article  CAS  PubMed  Google Scholar 

  31. Houssiau FA, D’Cruz D, Sangle S, et al. Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis. 2010;69:2083–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Dooley MA, Jayne D, Ginzler EM, et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2011;365:1886–95.

    Article  CAS  PubMed  Google Scholar 

  33. Ginzler E, Sharon E, Diamond H, Kaplan D. Long-term maintenance therapy with azathioprine in systemic lupus erythematosus. Arthritis Rheum. 1975;18:27–34.

    Article  CAS  PubMed  Google Scholar 

  34. Austin 3rd HA, Illei GG, Braun MJ, Balow JE. Randomized, controlled trial of prednisone, cyclophosphamide, and cyclosporine in lupus membranous nephropathy. J Am Soc Nephrol. 2009;20:901–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Cattran DC, Alexopoulos E, Heering P, et al. Cyclosporin in idiopathic glomerular disease associated with the nephrotic syndrome: workshop recommendations. Kidney Int. 2007;72:1429–47.

    Article  CAS  PubMed  Google Scholar 

  36. Waldman M, Austin 3rd HA. Treatment of idiopathic membranous nephropathy. J Am Soc Nephrol. 2012;23:1617–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Navarra SV, Guzman RM, Gallacher AE, et al. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377:721–31.

    Article  CAS  PubMed  Google Scholar 

  38. Dhaun N, Kluth DC. Belimumab for systemic lupus erythematosus. Lancet. 2011;377:2079–80; author reply 80–1.

    Article  PubMed  Google Scholar 

  39. Amigo MC, Garcia-Torres R, Robles M, Bochicchio T, Reyes PA. Renal involvement in primary antiphospholipid syndrome. J Rheumatol. 1992;19:1181–5.

    CAS  PubMed  Google Scholar 

  40. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295–306.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Neeraj Dhaun (Bean) MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

(Bean), N.D., Bellamy, C.O.C., Kluth, D.C. (2014). Systemic Lupus Erythematosus, Antiphospholipid Syndrome and the Kidney. In: Harber, M. (eds) Practical Nephrology. Springer, London. https://doi.org/10.1007/978-1-4471-5547-8_22

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5547-8_22

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5546-1

  • Online ISBN: 978-1-4471-5547-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics