Chronic Active Hepatitis with Lupus Nephritis

SUMMARY

The wire loop renal lesion of systemic lupus erythematosus (SLE) in one patient with the clinical features of postnecrotic cirrhosis and a "lupoid hepatitis syndrome" and in another patient with the clinical features of xanthomatous biliary cirrhosis were of interest because the deaths of both patients were caused by their renal lesion. Both patients had pathological features of chronic active hepatitis as well as renal lesions characteristic of SLE. A review of the pathology of SLE indicated that patients with SLE apparently do not die of liver disease and have only minimal changes in their liver caused by the SLE. On the other hand, numerous patients with chronic active hepatitis have developed a nonspecific nephritis. These two patients with long-standing, active hepatitis presented completely different clinical courses during their illnesses, but both died with chronic active hepatitis and lupus nephritis. This sequence of events proves that patients with active chronic hepatitis and nephritis can have a progression of their nephritis to such an extent that death due to renal failure ensues. The presence of active nephritis in a patient with chronic active hepatitis is further indication for immunosuppressive therapy and should provide a model for the further study of "autoimmunity."