1 Lupus Nephritis-Final-2 RA - Lupus Nephritis LaTina...

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Lupus Nephritis Lupus Nephritis LaTina Stover Nicole Lee Tarsheka Green Rochelle Allen NURS 250: Medical-Surgical III Instructor: Shelly Baldwin April 28, 2016
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Introduction Introduction LaTina Stover
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Objective 1 Identify different classifications of lupus nephritis. Identify treatment plan for Lupus Nephritis by being aware of drug therapy and ways to aide in improved kidney function. Identify the signs and symptoms of LN.
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Background Systemic lupus erythematosus (SLE) Clinical Manifestations & Complications Dermatologic Problems Musculoskeletal Problems Cardiopulmonary Problems Renal Problems Nervous System Problems Hematologic Problems Infection (Lewis, Heitkemper, Dirkson, O’Brien, & Bucher, 2014)
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Renal Problems Lupus Nephritis (LN) 40% occur w/SLE Symptoms occur 5 years after onset of SLE Mild= proteinuria Rapidly progressive = glomerulonephritis End-stage kidney disease (Lewis et al., 2014, pg. 1582-1583)
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Situation Pathogenesis Glomerulonephritis First component Second component Classification of Lupus Nephritis Class I Class II Class III Class IV Class V Class VI (Lawrence & Vecihi, 2015)
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Evidence Based Article Treatment Options for Proliferative Lupus Nephritis Mycophenolate Mofetil (MMF) Cyclophosphamide (CYC) (Bailey, Rowley, & Bernknopf, 2011)
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Normal Class I Renal biopsy reveals an essentially normal kidney by light, electron and immunofluorescence microscopy . Patients usually do not have clinical disease. (Bailey et al., 2011)
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Mesangial Glomerulonephritis Class IIa have minimal or no significant changes by light microscopy although there may be immunofluorescent evidence of immune deposits confined to the mesangium and/or dense deposits by EM. Class IIb shows definite glomerular mesangial hypercellularity by light microscopy, which is confined to the centrilobular regions away from the vascular pole. Clinically, these patients have mild to moderate evidence of renal involvement and in general have a good prognosis. (Bailey et al., 2011)
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Focal Segmental Proliferative Glomerulonephritis CLASS III Focal segmental proliferative lupus nephritis with necrosis or sclerosis affecting fewer than 50% of glomeruli. Up to one third of patients have nephrotic syndrome and glomerular filtration is impaired in 15-25%. . (Bailey et al., 2011)
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Diffuse Proliferative Glomerulonephritis CLASS IV Characterized by diffuse proliferative GN. Most glomeruli show cell proliferation often with crescent formation and sometimes nuclear debris represented by “hematoxylin” bodies. By EM, the characteristic findings are subendothelial deposits and mesangial deposits. Sometimes, there may be sub-epithelial and intramembranous deposits.
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