Doublethink in Lupus Nephritis

Selecting a treatment strategy for azotemic patients with lupus nephritis is a stress-inducing exercise. It has been suggested that the type and extent of glomerular abnormalities offer the best guidance for therapy. Study of percutaneous renal biopsy specimens from patients with systemic lupus erythematosus (SLE) who have proteinuria, gross or microscopic hematuria, or a diminished creatinine clearance will in almost all instances discover pathological changes in glomeruli. Mild glomerular pathological changes transform to diffuse proliferative glomerulonephritis sufficiently frequently, however, to preclude constant association of a benign clinical course with a favorable biopsy specimen.1Changes from severe proliferative to membranous glomerulonephritis, from focal or diffuse proliferative glomerulonephritis to membranous glomerulonephritis, and from membranous to diffuse proliferative glomerulonephritis occur, indicating the folly of dogmatically ascribing any clinical syndrome to a fixed histological glomerular pattern. While it is generally true that development of diffuse proliferative glomerulonephritis in SLE is an ominous prognostic