Systemic lupus erythematosus : from diagnosis to prognosis

Rijnink, E.C. (2017)

Doctoral Thesis

The clinical manifestations and outcomes of systemic lupus erythematosus (SLE) are remarkably heterogeneous. In this thesis, issues relating to the diagnosis and prognosis of SLE were studied, focussing on the application of histopathologic evaluation in conjunction with clinical features in the setting of lupus nephritis (LN) and neuropsychiatric SLE (NP-SLE). In the first part, we demonstrated that classification criteria for SLE cannot be unequivocally applied to patients from nephrology clinics who present with full house glomerular deposits suggestive of LN/SLE. The patients with full house glomerular deposits without clinical SLE represented a distinct entity with a remarkably poor renal outcome. In the second part, clinical and histopathologic determinants of renal outcome were investigated to improve prognostication in LN. First, we identified a subgroup of patients with class III/IV LN with favourable renal outcome indicating that the current classification warrants refinement. Next, we identified prognosticators that may add to the current histopathologic classification of LN. The last part of this thesis was focused on the aetiopathogenesis of SLE, in which the complement system was identified as an important player and thereby therapeutic target in neuropsychiatric lupus and in which pregnancy-acquired microchimerism in relation to the occurrence of SLE was further investigated.

• Lupus
• Nephritis
• Pathology
• Rheumatology
• Chimerism
• Pregnancy

• All authors: Rijnink, E.C.
• Supervisor: Bruijn, J.A.
• Co-supervisor: Bajema, I.M.; Teng, Y.K.O.
• Committee: Berden, J.H.M; Bootsma, H.; Huizinga, T.W.J.; Smit, V.T.H.B.M.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2017-10-12
• ISBN (print): 9789462996663