Author/Editor		Luzar, Boštjan; Ferluga, Dušan
Title		Role of lipids in the progression of the renal disease in systemic lupus erythematosus patients
Type		članek
Source		Wien Klin Wochenschr
Vol. and No.		Letnik 112, št. 15-16
Publication year		2000
Volume		str. 716-21
Language		eng
Abstract		Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease marked by immune-complex mediated lesions in small blood vessels of various organs, especially the kidneys, although other factors may also be implicated in the pathogenesis of the disease. This article focues on the role of lipids in the progression of glomerular, vascular and tubulo-interstitial lesions in two patients lupus nephritis associated with pronounced hyper- and dyslipidemia. The pathogenesis of progressive glomerulosclerosis in both patients appears to be multifactorial. In addition to immune complex mediated lupus glomerulonephritis, progressively active in the first patient, severe nephrotic-range persistent proteinuria, arterial hypertension associated with hyperfiltration and hyperperfusion injuries and, to a minor extent, hyper- and dyslipidemia were observed. Immunological and non-immunological factors were shown to contribute to the development of tubulo-interstitial lesions. In both patients, in addition to local immune deposits, prominent tubulo-interstitial lipid deposits were probably causally related to both hyperlipidemia and the increased permeability of the glomerular filtration barrier. Tubular lesions were highlighted by intracytoplasmic lipid droplets as well as small cleft-like spaces found to be impacted in the tubular lumina. They were seen to penetrate tubular epithelial cells and eventually lodge in the interstitium, surrounded by mononuclear cell infiltrates and foam cells. In both patients, hypertensive angiopathy and extraglomerular vascular immune deposits were demonstrated. In addition, in the second patient, arteriolar and small arterial hyaline was found at the age of 28 years to be full of lipids and calcium precipitates, suggesting a peripheral atherosclerosis-like process which never occurs as a natural age-related condition. (Abstract truncated at 2000 characters).
Descriptors		LUPUS NEPHRITIS HYPERLIPIDEMIA ADULT BIOPSY NEPHROTIC SYNDROME IMMUNE COMPLEX DISEASES ATHEROSCLEROSIS