Lupus nephritis: pathophysiology, diagnosis, and collaborative management

Lupus nephritis (LN) is a complex disease. The pathophysiology involves the glomerulus and mesangium, and its manifestations are exhibited in extensive renal lesions. The World Health Organization (WHO) has developed a classification system to assist clinicians in understanding the severity of renal involvement. The diagnosis of systemic lupus erythematosus (SLE) and LN can be difficult because of their often vague symptoms and the long list of differential diagnoses. However, it is important to identify LN quickly to have an impact on a patient's prognosis. The 11 criteria established by the American Rheumatology Association provide a framework for identifying clinical manifestations of SLE. Management of LN, which may be guided by renal biopsy findings, includes pharmacologic therapy, management of drug toxicities, dialysis, transplantation, controlling symptoms (e.g., hypertension), patient education, and psychosocial support for the patient and family. This article focuses on the pathophysiology, diagnostic approach, and collaborative management of LN.