Lupus Podocytopathy: An Overview

Oliva-Dámaso, Néstor; Payan, J; Oliva-Damaso, Elena; Pereda, Teresa; Bomback, Andrew S.

doi:10.1053/j.ackd.2019.08.011

Cited by 43 publications

(34 citation statements)

References 34 publications

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“…Overall, the prevalence of LP represents approximately 1% of all LN biopsies. Proposed criteria for the diagnosis of LP include the following: (1) nephrotic syndrome in a patient with SLE; (2) presence of diffuse podocyte effacement on electron microscopy; and (3) absence of immune subendothelial or subepithelial deposits by immunofluorescence and electron microscopy [55]. Although normal glomeruli are usually observed on light microscopy, lesions of focal segmental glomerulosclerosis (FSGS) with or without mesangial proliferation can also be observed.…”

Section: Special Situations (Lupus Podocytopathy Membranous Nephropamentioning

confidence: 99%

Update on Lupus Nephritis: Looking for a New Vision

Morales

Galindo

Trujillo

et al. 2020

Nephron

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Lupus nephritis (LN) is one of the most common manifestations of systemic lupus erythematosus (SLE), affecting approximately 40% of patients with lupus. It represents a major risk factor for morbidity and mortality, and 10% of patients with LN will develop end-stage kidney disease (ESKD). Therefore, there are a number of areas for improvement in the field of LN such as the search for new clinical biomarkers with a more accurate correlation with lupus activity and the redefinition of the histological classification into different subgroups in order to guide a personalized treatment. Although the role of protocol repeat kidney biopsies in LN is controversial, recent publications suggest that repeat histological assessment can be useful in guiding therapeutic decisions that may yield toward precision medicine. In the last decade, LN therapy has remained largely unchanged, with a probability of achieving complete or partial remission not exceeding 60–70%. Thus, optimization of old treatment strategies and search for new agents are urgently needed in order to improve outcomes such as mortality or development of ESKD. Future trials should focus in addressing unanswered issues such as the appropriate dose and duration of immunosuppressive treatment, timing of steroid withdrawal, and drug toxicity. In addition, data are still lacking regarding pregnancy and kidney transplantation in LN and knowledge about these important areas is essential for the management of a subset of patients with SLE. In summary, several major gaps are still present in the therapeutic approach and follow-up of patients with LN. The development of new clinical trial designs will be crucial in the search to improve long-term outcomes.

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Section: Special Situations (Lupus Podocytopathy Membranous Nephropamentioning

confidence: 99%

Update on Lupus Nephritis: Looking for a New Vision

Morales

Galindo

Trujillo

et al. 2020

Nephron

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“…e lupus patient, who is described here, presented with nephrotic proteinuria with or without symptoms of nephrotic syndrome in four separate circumstances. In two occasions, histopathology revealed lupus membranous nephropathy (WHO class V) [1,2] and in the other two, lupus podocytopathy, manifested as minimal-change disease. e probability of lupus podocytopathy, manifested as idiopathic minimal-change disease or idiopathic focal segmental glomerulosclerosis, has been estimated by Hertig et al to be in <1 in 10,000 [3].…”

Section: Discussionmentioning

confidence: 95%

“…Overall, the proposed criteria for the diagnosis of lupus podocytopathy in Oliva-Damaso and Chen [1,13] are similar. In addition, Oliva-Damaso and co-authors proposed criteria for the clinical classification and also the inclusion of lupus podocytopathy in the classification of lupus nephritis, in between class II and Class III lupus nephritis.…”

mentioning

confidence: 88%

“…e performance of each patient with kidney abnormalities is also variable but most importantly, different clinical settings and histopathological patterns may be found in the same patient over time. Nephrotic syndrome in patients with SLE is classically associated with proliferative glomerulonephritis or membranous nephropathy (WHO class III, IV, and V) [1,2]. However, lupus podocytopathy associated with nephrotic proteinuria has been repeatedly reported in these patients [3], which is characterized by absent or scarce capillary wall immune complex deposition, or cellular proliferation, but diffuse effacement of the epithelial cell foot processes, identical to the histopathological pattern of minimal-change disease [4].…”

Section: Introductionmentioning

confidence: 99%

“…However, lupus podocytopathy associated with nephrotic proteinuria has been repeatedly reported in these patients [3], which is characterized by absent or scarce capillary wall immune complex deposition, or cellular proliferation, but diffuse effacement of the epithelial cell foot processes, identical to the histopathological pattern of minimal-change disease [4]. e diagnostic and classification criteria for lupus podocytopathy, which have been proposed by the American College of Rheumatology include the clinical diagnosis of full nephrotic syndrome combined with histopathology showing normal glomeruli by light microscopy, i.e., minimal-change disease (MCD), or focal segmental glomerulosclerosis (FSGS) with or without mesangial proliferation but with no endocapillary proliferation, necrosis, and/or crescents by immunofluorescence microscopy without deposits confined to the mesangium, and by electron microscopy diffuse and severe (typically >70%) foot process effacement [1]. It is considered to be rather pertinent than a simple coincidence [3], given the statistical unlikelihood of concurrent active lupus and idiopathic minimal change glomerulopathy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Various Forms of Nephrotic Syndrome in a Patient with Systemic Lupus Erythematosus

Lionaki

Liapis

Vallianou

et al. 2020

Case Reports in Nephrology

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Kidney involvement is frequent in patients with systemic lupus erythematosus (SLE), although it may not be present from disease onset. Renal lupus itself is highly heterogenous with respect to the combination and/or severity of clinical and/or laboratory manifestations. This is a case of a 45-year-old Caucasian female with an established diagnosis of SLE, who presented four times with new onset of proteinuria during a follow-up time of ten years, since the diagnosis of SLE. Specifically, she experienced two episodes of lupus membranous nephropathy, and after she achieved remission, she developed twice overt nephrotic syndrome associated with new and biopsy proven lupus podocytopathy. All these episodes of nephrotic syndrome were combined with systemic symptoms, attributed to lupus itself, while serological activity of lupus was also noted. This case highlights the importance of performing a kidney biopsy in all patients with SLE who have new renal manifestations, including nephrotic proteinuria.

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