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Immunopathology of lupus nephritis

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Abstract

When patients with systemic lupus erythematosus (SLE) present with urinary abnormalities, a renal biopsy is usually needed to rule out or confirm lupus nephritis. Renal biopsy is also needed to define the type of renal manifestation as different entities are associated with different outcomes; hence, renal biopsy results shape lupus management. But why does lupus nephritis come in different shapes? Why do patients with SLE often show change over time in class of lupus nephritis or have mixed forms? How does autoimmunity in SLE evolve? Why does loss of tolerance against nuclear antigens preferentially affect the kidney? Why are immune complex deposits in different glomerular compartments associated with different outcomes? What determines crescent formation in lupus? In this review, we discuss these questions by linking the latest information on lupus pathogenesis into the context of the different classes of lupus nephritis. This should help the basic scientist, the pathologist, and the clinician to gain a more conceptual view on the immunopathology of lupus nephritis.

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Acknowledgments

This work was supported by Deutsche Forschungsgemeinschaft AN372/11-1 and GRK 1202. The authors thank Jyaysi Desai for her help with Fig. 1.

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Authors and Affiliations

  1. Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, 80336, Munich, Germany

    Hans-Joachim Anders

  2. MCN C3310, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Agnes B. Fogo

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  1. Hans-Joachim Anders
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  2. Agnes B. Fogo
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Correspondence to Hans-Joachim Anders.

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This article is a contribution to the special issue on Immunopathology of Glomerular Diseases - Guest Editors: P. Ronco and J. Floege

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Anders, HJ., Fogo, A.B. Immunopathology of lupus nephritis. Semin Immunopathol 36, 443–459 (2014). https://doi.org/10.1007/s00281-013-0413-5

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