The kidney in autoimmune rheumatic disease

4 big ones

rheumatoid arhtritis

SLE

Sjogren's

systemic sclerosis

Rheumatoid arthritis

• amyloid infiltration (AA), a proliferative glomerulonephritis or side effects of drugs may cause a problem here

SLE

• wire-loop lesions are seen (thickened capillary loops) along with immunofluorescence for Igs and complement
• they lose protein and renal function rapidly deteriorates. Treat with immunosupressants

Sjogren's

• These get an interstitial nephritis, a proteinuria, often with tubular dysfunction
• Improves with steroids if treatment warranted

Systemic sclerosis

• Obliteration of the arterioles is seen, with a classical onion-skin appearance.
• Scleroderma renal crisis has: acute renal failure, haemolytic anaemia and accelerated-phase hypertension
• Treat the BP with ACEi

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