Anatomical pathology provides a roadmap for lupus patients
Systemic lupus erythematosus (SLE) can be difficult to diagnose because of its wide range of symptoms. It is an autoimmune disease in which a person’s immune system attacks their body’s own cells. It can affect the skin and many internal organs including the brain, joints and blood vessels. Anatomical Pathologists examine biopsies to identify which of these are affected and how severely. They then monitor this often-elusive disease that can ultimately require a kidney transplant, as in the case of singer Selena Gomez.
When lupus affects the kidneys it’s called lupus nephritis. This is a type of glomerulonephritis where the glomeruli (clusters of small blood vessels that form the kidney’s basic filtration unit) become inflamed.
“Diagnosis of lupus nephritis is confirmed by a renal biopsy where an anatomical pathologist makes the diagnosis and then stages the disease. Further biopsies are then needed to monitor the progress of the disease, plan the patient’s treatment, and follow up the progress of the kidney after treatment,” explained Dr Tony Landgren, Anatomical Pathologist at the Royal Melbourne Hospital and Australian Clinical Labs.
He said lupus nephritis is staged into five classes ranging from Class 1 minimal disease to Class 2 mild disease and Classes 3-5, more severe disease. Progression of the kidney disease can lead to dialysis and potentially a kidney transplant.
“In many cases lupus nephritis can be kept under control for long periods of time with treatment. Other times the deterioration is very fast. Often teenagers and young adults are diagnosed with lupus, and if their kidneys are involved they can progress to dialysis and potentially a kidney transplant very quickly. It’s devastating for them,” Dr Landgren explained.
“It’s also very important not to assume that signs of kidney disease in a person diagnosed with lupus are automatically deemed to be lupus nephritis. Kidney disease can result from other causes such as vascular disease or IgA nephropathy, or it might be from more than one disease process occurring at the same time such as lupus. This is why examining the kidney tissue to accurately diagnose the cause of kidney disease is important.”
Dr Landgren said once a patient has a kidney transplant, protocol biopsies at designated intervals are used to check the new kidney’s status. If there are signs of a problem developing then an indication biopsy will be requested to find out why. Problems might include organ rejection, infection, blood vessel disease, drug toxicity and recurrence of lupus nephritis in the new kidney.
Although Selena Gomez now has a new kidney, lupus is a disease for life. This means monitoring the disease is for life as well. Much of this process falls under the watch of Anatomical Pathologists who provide a valuable roadmap into the future for every lupus patient.
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This article appeared in the October 2017 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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