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Renal Involvement in Systemic Lupus Erythematosus

Dr. Laurent ARNAUD @Lupusreference

#Renal #diseases #SLE #Systemic #Lupus #Erythematosus #venn #nephrology
Renal Involvement ... #diseases #SLE ... Erythematosus #venn #nephrology ... #nephritis #classification ... #types #rheumatology
Renal Tubular Acidosis (RTA) 
Type 1 - Failure of secretion
Type 2 - Bicarbonate wasting
Type 4 -
Renal Tubular Acidosis ... Mixed* - Inherited carbonic ... #Tubular #Acidosis ... #RTA #types #classification ... #nephrology #diagnosis
Causes of High-anion Gap and Non-anion Gap Metabolic Acidosis
Causes of High-anion Gap Acidosis:
 • Lactic acidosis
Ketoacidosis: Diabetic ... failure (acute and chronic ... Renal acidosis ... Chronic progressive ... diagnosis #causes #nephrology
Hyperkalemia: Diagnostic algorithm
Decreased renal potassium excretion
 • Acute renal failure
 • Chronic renal failure
 • Drugs
Increased
Hyperkalemia: Diagnostic ... failure • Chronic ... • Drugs • Diabetic ... 1 #Hyperkalemia ... Diagnosis #algorithm #nephrology
Hyperkalemia - Differential Diagnosis Framework

PseudoHyperkalemia:
 • Lab error
 • Traumatic venipuncture
 • Hemolysis, thrombocytosis, leukocytosis
 •
(Uncontrolled diabetes ... - Metabolic acidosis ... insufficiency/Failure • SLE ... • Type IV RTA ... potassium #high #nephrology
Causes of Hypokalemia - Differential Diagnosis Algorithm
Defining the cause of hypokalemia starts by measuring urinary K
gastrointestinal K loss • Renal ... • Renal tubular ... acidosis (type ... Ureterosigmoidostomy, Diabetic ... algorithm #causes #nephrology
Causes of Hyponatremia - Differential Diagnosis Algorithm
Hypovolemia, UNa > 20: 
 • Renal losses, Diuretic excess,
losses, Diuretic ... tubal acidosis ... : • Acute or chronic ... Hypervolemia, UNa ... Algorithm #Causes #nephrology
Classification of Diabetes Insipidus

Central or neurogenic diabetes insipidus:
 - Congenital - Structural malformations affecting the hypothalamus
Classification of ... Acquired - Primary renal ... , hypercalcemia) ... #Classification ... #Types #Nephrology
Hyperkalemia - Differential Diagnosis Framework

PseudoHyperkalemia:
 • Lab error
 • Traumatic venipuncture
 • Hemolysis, thrombocytosis, leukocytosis
 •
(Uncontrolled diabetes ... - Metabolic acidosis ... insufficiency/Failure • SLE ... • Type IV RTA ... potassium #high #nephrology
Management of Lupus Nephritis
Lupus nephritis (LN) in 10 to 40% of SLE
Hallmark = proteinuria 20.5 g/g
in 10 to 40% of SLE ... or 0.5 g/day → renal ... severity (ISN/RPS classification ... by 12 months Classification ... #rheumatology #nephrology