Abstract:

SLE patients clinically presenting with nephrotic syndrome demonstrated minimal change disease (MCD), mesangial hypercellularity (MsP) or focal segmental glomerulosclerosis (FSGS); on electronic microscopy, diffuse effacement of the podocyte foot processes was the single morphologic feature in the absence of subepithelial or subendothelial electron dense deposits, which was called as lupus podocytopathy. Lupus podocytopathy with glumerular change of MCD or MsP presented with a low rate of hematuria, and sensitive to glucocorticoid. In maintenance treatment, the relapse rate of glococorticoid monotherapy reached up to 90%, and glococorticoid plus other immunosuppressive agents could significantly lower the rate of relapse. While patients with FSGS suffered a higher rate of acute kidney injure and lower rate of remission to glucocorticoid. Longterm outcomes of these patients were optimistic, but pathological transition occurred after relapse. The unique clinicalpathological features indicated lupus podocytopathy should be classified as a special subtype and enrolled in the current pathological classification of lupus nephritis.

Key words: lupus nephritis, lupus podocyto, pathypathological classification