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Silent Lupus Nephritis

Studies in which renal biopsy was performed in patients without any clinical evidence of renal disease found mesangial, focal, or diffuse proliferative glomerulonephritis in some patients.1–6 For example, In a study, kidney biopsy was offered to all patients with systemic lupus erythematosus observed at a Japanese hospital over 11 years whether or not clinical signs of renal disease were present.6 Of the 195 patients who had adequate biopsies, 86 had no clinical renal involvement. Of these 86 patients without clinical renal disease, 13 (15%) had either class III or IV lupus nephritis and 9 (10%) had class V (membranous) disease.

Renal disease in patients with silent lupus nephritis often remains clinically silent and is associated with a benign renal outcome.2,3,6 This was illustrated in a series of 18 patients with silent lupus nephritis (half of whom were treated with glucocorticoids with or without cyclophosphamide) observed at a single center.3 At a mean postbiopsy follow-up of 13 years, the mean serum creatinine was 0.8 mg/dL (71 μmol/L), the mean creatinine clearance was 108 mL/min, and all had a normal urinalysis. However, 15 of these patients had only mesangial disease at initial biopsy.

References

  • Mahajan SK, Ordóñez NG, Feitelson PJ, et al. Lupus nephropathy without clinical renal involvement. Medicine (Baltimore). 1977;56:493.
  • Leehey DJ, Katz AI, Azaran AH, et al. Silent diffuse lupus nephritis: long-term follow-up. Am J Kidney Dis. 1982;2:188.
  • Gonzalez-Crespo MR, Lopez-Fernandez JI, Usera G, et al. Outcome of silent lupus nephritis. Semin Arthritis Rheum. 1996;26:468.
  • Wada Y, Ito S, Ueno M, et al. Renal outcome and predictors of clinical renal involvement in patients with silent lupus nephritis. Nephron Clin Pract. 2004;98:c105.
  • Zabaleta-Lanz ME, Muñoz LE, Tapanes FJ, et al. Further description of early clinically silent lupus nephritis. Lupus. 2006;15:845.
  • Wakasugi D, Gono T, Kawaguchi Y, et al. Frequency of class III and IV nephritis in systemic lupus erythematosus without clinical renal involvement: an analysis of predictive measures. J Rheumatol. 2012;39:79.