Autoimmunity plays a major role in the pathogenesis of lupus nephritis. The
immunologic mechanisms include production of autoantibodies directed against
nuclear elements. These autoantibodies form pathogenic immune complexes. In the
kidneys, deposition of these immune deposits initiates an inflammatory response
by activating the complement cascade and recruiting inflammatory cells that can
subsequently be observed on biopsy specimens. At least three potentially
overlapping, immuno-pathogenic mechanisms are supported by experimental data.
First, circulating immune complexes consisting chiefly of DNA and anti-DNA are
deposited in the kidney. Resulting complement activation and chemotaxis of
neutrophils leads to a local inflammatory process. Second, in situ formation of
antigen and antibody complexes may similarly lead to complement activation and
leucocyte mediated injury. Third, antibodies against specific cellular targets
may produce renal injury.
Symptoms related to active nephritis may include peripheral edema secondary
to hypertension or hypoalbuminemia. Extreme peripheral edema is more common in
persons with diffuse proliferative or membranous lupus nephritis because these
renal lesions are commonly associated with heavy proteinuria.
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