Format

Send to

Choose Destination

See 1 citation in Nat Rev Nephrol 2017:

Nat Rev Nephrol. 2017 Aug;13(8):483-495. doi: 10.1038/nrneph.2017.85. Epub 2017 Jul 3.

Redefining lupus nephritis: clinical implications of pathophysiologic subtypes.

Author information

1
Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, P. R. China.
2
Department of Nephrology, Peking University International Hospital, 1 Zhongguancun Life and Science Street, Changping District, Beijing 102206, P. R. China.
3
Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, 90048 California, USA.
4
Department of Medicine, David Geffen School of Medicine at UCLA, 8 Bethany, Laguna Niguel, 92677 California, USA.
5
Peking-Tsinghua Center for Life Sciences, 5 Summer Palace Street, Haidian District, Beijing 100871, P. R. China.

Abstract

Systemic lupus erythematosus (SLE) is associated with a broad spectrum of clinical and immunologic manifestations, of which lupus nephritis is the most common cause of morbidity and mortality. The development of nephritis in patients with SLE involves multiple pathogenic pathways including aberrant apoptosis, autoantibody production, immune complex deposition and complement activation. The 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification system for lupus nephritis was widely accepted with high intraobserver and interobserver concordance to guide therapeutic strategy and provide prognostic information. However, this classification system is not based on the underlying disease pathophysiology. Some additional lesions that contribute to disease presentation, including glomerular crescents, podocyte injury, tubulointerstitial lesions and vascular injury, should be recognized. Although outcomes for patients with lupus nephritis have improved over the past 30 years, treatment of this disease remains challenging and is best approached on the basis of the underlying pathogenesis, which is only partially represented by the various pathological phenotypes defined by the ISN/RPS classification. Here, we discuss the heterogeneous mechanisms involved in the pathogenesis of lupus nephritis and how improved understanding of underlying disease mechanisms might help guide therapeutic strategies.

PMID:
28669995
DOI:
10.1038/nrneph.2017.85
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Nature Publishing Group
Loading ...
Support Center