Systemic Lupus Erythematosis (SLE)

Chronic auto-inflammatory disease of unknown origin

Aetiology

  • Women in 20-30s most commonly affected
  • Higher incidence in African Americans and Hispanics
  • Affects skin, joints, kidneys, lungs, nervous system, serous membranes

Pathophysiology

Lupus nephritis

  • Up to 50% of lupus patients will have renal involvement at presentation, and up to 60% during the course of their disease
  • Most frequently observed abnormality is proteinuria
  • A number of types of renal disease can occur and are differentiated by renal biopsy - ISN classification I-VI

Clinical presentation

  • Fever, weight loss
  • Arthralgia, synovitis, arthritis
  • Pleuritis, pericarditis
  • 'Butterfly' facial rash, photodermatosis, alopecia
  • Anaemia, leukopenia, thrombocytopenia, thromboses
  • Renal involvement

Investigations

  • Bloods - raised inflammatory markers, low complement
  • Immunology - ANA positive, anti-dsDNA present in ~70%
  • Urinalysis - proteinuria +/- microscopic haematuria
  • Renal biopsy required

Management

  • Immunosuppresion - level depends on presentation and severity