Lupus nephritis clinico pathological correlation

Abstract

In 52 cases studied a good correlation existed between renal function and underlying histology in lupus nephritis. In patients with normal urinary finding or mild abnormalities, 38% had no obvious or focal lesions, 54% had diffuse proliferative lesions, the majority of which were mild and 8% had membrano proliferative lesions. In the moderate and severe groups, 57% had diffuse proliferative lesions half of which had necrosis or crescent formation and 36% had membranous or membrano proliferative changes. The data further show that the extent and site of deposition of electron dense deposits can be correlated with clinical behavior. Heavy subendothelial deposits were only found in the group with moderate to severe renal dysfunction. On immunofluorescence, all patients studied had deposition of IgG. The majority of them also had deposition of complement C 3, fibrin and fibrinogen. Significant differences were found in deposits of IgA, IgD and IgM between the normal and mild renal groups on the one hand and moderate and severe renal groups on the other. All 52 patients had received various medications including steroids, chloroquine, azathioprine and cyclophosphamide. Thirty five of these patients had been followed up for more than 1 yr. With the exception of 2 patients, the renal function of the rest had either improved or remained stable. The 2 patients whose renal function had deteriorated had heavy dense deposits in the subendothelial, subepithelial and mesangial sites. There were 6 deaths.