View Full Version : Just curious...

08-17-2005, 08:54 PM

I have Class V Membranous Lupus Nephritis... I have been reading for the past month as much as I have been able to handle, yet, I still don't fully understand the classifications, and their severity, and how or if they progress or overlap...

Is it possible that this specific type of lupus could affect another part of my body, or if the lupus was affecting another part of my body is that a different classification or type?

Also, in the past two weeks I have developed a rash on my chest and back and I believe it's also on the lower part of my cheeks... It isn't the butterfly rash, it's just red bumps... Could this be lupus related or am I just allergic to something?

Lots of questions... Maybe next time I should space them out more...

Any insight is greatly appreciated!!!

08-19-2005, 03:39 PM
Hi Solesinger:
Here is what I found about the classes of Lupus Nephritis- first, let me give you a definition of glomeruli -
In the kidney, a tiny ball-shaped structure composed of capillary blood vessels actively involved in the filtration of the blood to form urine. The glomerulus is one of the key structures that make up the nephron, the functional unit of the kidney.:

World Health Organization Classification of Lupus Nephritis
Class I: normal glomeruli (~8% of biopsies)
Class II: pure mesangial alterations (~40% of biopsies)
Class III: focal glomerulonephritis (~15% of biopsies)
Class IIIA: focal segmental glomerulonephritis (~12% of biopsies)
Class IIIB: focal proliferative glomerulonephritis
Class IV: diffuse glomerulonephritis (~25% of biopsies)
Class V: diffuse membranous glomerulonephritis (~8% of biopsies)
Class VI: advanced sclerosing glomerulonephritis
Nephrotic Syndrome patients present with edema (swelling), usually beginning with lower extremities. They also have coagulopathy(blood clotting) and hypercholesterolemia (hith cholesterol level)
Class II or V - Renal lupus lesions that ead to nephrosis- degenerative lesions of the renal tubules - with little or no azotemia (abnormally high level of nitrogen-type wastes in the bloodstream caused by conditions that reduce blood flow to the kidneys)
Most renal biopsies are Class III or IV (with poorer prognosis)

With reference to your rashes, they are most likely lesions and possibly subacute cutaneous lesions. There are two clinical forms of SCLE lesions:
The papulosquamous variety of SCLE is characterized by red (erythematous) plaques-elevated areas of scaly skin with distinct margins.
This form of SCLE can resemble psoriasis. These lesions appear most commonly on the sun-exposed areas of the arms, shoulders, neck, back and trunk, with the face being affected less frequently.
Here is information about Lupus Lesions:
There are two specific lesions associated with lupus erythematosus: discoid lesions (characteristic of discoid lupus erythematosus), and coin-shaped, non-scarring lesions (characteristic of subacute cutaneous lupus erythematosus). The discoid lupus lesions may occur in the scalp producing a scarring, localized baldness termed alopecia. At times, these discoid lesions may appear over the central portion of the face and nose producing a characteristic butterfly rash.
Specific rashes
1) The butterfly blush or rash is a faint or prominent red rash over the malar area and the bridge of the nose. The rash does not go into the sides of the nostrils or down the fold between the nose and the outer part of the lips. These areas are always spared and look white in contrast to the red rash of the cheeks and bridge of the nose. Sometimes the rash is flat, and sometimes it is elevated. It may be in the form of red blotches or may be completely red over the area. The rash may be itchy, especially if it looks more like a rash than a blush. This rash is typical of SLE but is present in only about 30 percent of patients.
2) Subacute cutaneous lupus lesions are of two major types.
The first type looks like red pimples when the rash first comes out; as the rash persists, these pimples become bigger, and scales appear as the rash persists. Patients complain about the rash being very itchy. The rash usually appears on the face, chest, or arms and commonly comes on after sun exposure. The rash usually worsens after more sun exposure.
The second type starts out as a flat lesion and gets bigger by expanding outward. The center may become less red and may even clear up completely so that, after a while, this rash looks like many circular red areas with clear holes in their centers. The rash appears on the face, chest, arms, and back. It is very sensitive to the sun and, like the other form of subacute cutaneous lesions, usually is very itchy. The rash of subacute cutaneous lupus usually heals without scarring, or leaves a non-depressed scar or area of depigmentation where the rash had been.

Non-specific rashes
Non-specific rashes are seen in diseases other than lupus, but are extremely common in people with SLE. Patients may develop a red blotchy rash similar to the rash caused by a number of viruses, and similar to the rash caused by a variety of drugs (so-called drug-rash). These blotches may or may not be elevated and may be pink or red. They generally are found on the face, chest, back, and upper arms, and may or may not be itchy. This type of rash disappears quickly if patients are treated with corticosteroids for their other complaints.
Vasculitic rashes are seen frequently in people with SLE, especially in acutely ill patients. These rashes are non-specific because they may be present in patients who do not have lupus. For example, a small number of individuals with rheumatoid arthritis develop vasculitic rashes. There are a wide variety of rashes due to vasculitis, including: tender bumps in the tips of the fingers or toes; rashes that look like splinters under the nailbeds; ulcers that form around the ankle joints or on the legs; and tender red bumps on the shins.
Let me know if this has been helpful at all!!
Peace and Blessings

08-20-2005, 05:49 AM
Thank you very much!!!! That was very helpful!

The only part I am still confused about is, (actually there are a few things)
since I have class V, can I also get like, class III or whatever? Does it progress like that or once you're in a class do you stay there? Also, since I have lupus nephritis, is it possible to also get lupus of the brain, or liver or...? Or is it pretty much always going to be my kidneys that I have to worry about? And one more... The things like rashes and RA (which I don't have, knock on wood) are those just general Lupus symptoms, like you can have them no matter what type of lupus you have, or is that a completely different type on top of lupus nephritis or whatever?

I have about a million and a half questions, and I try to ask my doctors when I see them, but, they have other patients too!!! I can't monopolize ALL their time!! LOL Though, if they'd give it to me I'd take it!!! So, I've been trying to look things up, but, sometimes it's hard to find the specific answer to my specific question, you know? Maybe I'm just not looking in the right places...

Anyway, thank you for your help! And if anyone knows the answer to one of my MILLION questions (I'm sure there will be more to come) it's greatly appreciated!!


08-25-2005, 07:27 AM
About a year ago, I went into the hospital with stage 3 kidney failure. My blood pressure was well over 195/165 and my feet, legs, and stomach had swollen to the point of stretch marks and being asked if I was pregnant. I am 5'6 usually about 130-140lbs. at the time of hospital admittance I was 185lbs due to edema. Anyway! I have a million suggestions and questions myself about what you are going thru- however I just realized the time, and I am about to be late for school! So, I will continue this reply when I get back. I apologize! Stay well- Mollie:)