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Lupus Nephritis

Author:

Vineel Kumar
Touro University - California, US

This information is provided for educational and informational purposes only and does not constitute providing medical advice or professional services.

What are the kidneys and what do they do?

The kidneys are two bean-shaped structures located on either side of the backbone. Kidneys play a very important role in the human body.
Each kidney has a million little filters (called glomeruli) that act as a sieve. As blood flows through these filters, the good things (like red blood cells, protein, sugar, etc.) are retained while excess water and waste products are removed via urine.

The kidneys also maintain our blood pressure, provide building blocks to maintain our red blood cells (hemoglobin), and also activate vitamin D to maintain healthy bones.

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What is Lupus Nephritis?

Lupus nephritis is a kidney disorder that occurs as a result of systemic lupus erythematosus (SLE), an autoimmune disease. In lupus nephritis, the body's immune system attacks the kidney tissues, causing inflammation and kidney damage. This can lead to proteinuria (excessive protein in the urine), hematuria (blood in the urine), high blood pressure, and swelling in the legs and feet. If left untreated, lupus nephritis can lead to end-stage kidney disease, requiring dialysis or kidney transplantation.

Who is at risk for Lupus Nephritis? 

People who have systemic lupus erythematosus (SLE) are at risk for developing lupus nephritis. SLE is more common in women than in men, and it often develops during the childbearing years. Lupus nephritis can occur at any age, but it is more commonly diagnosed in people in their 20s or 30s. Other factors that may increase the risk of developing lupus nephritis include: 

 

  • Genetics: Certain genetic factors may make some people more susceptible to developing SLE and lupus nephritis.

  • Ethnicity: Lupus nephritis is more common in people of African, Hispanic, and Asian descent than in people of European descent. In the United States, 1 out of every 250 African American women will develop lupus. However, among all patients with SLE, the risk of developing lupus nephritis was significantly higher in men, younger individuals, and Hispanics. 

  • Gender: Women are more likely than men to develop SLE. Nine out of ten people who have lupus are women. As noted before, among those with SLE, lupus nephritis is more common in men than women.

  • Smoking: Smoking may increase the risk of developing SLE and lupus nephritis.

  • Family history: People with a family history of SLE or lupus nephritis may be at a higher risk of developing the condition.

What are the signs and symptoms of Lupus Nephritis?

Damage and inflammation of the kidneys in lupus nephritis cause a variety of signs and symptoms. Some of the common signs and symptoms include:

  1. Proteinuria: This means excessive amounts of protein in the urine, which can cause foamy urine.

  2. Hematuria: This means blood in the urine, which may appear pink or red.

  3. Edema: This means swelling in the legs, ankles, or feet.

  4. High blood pressure: This is a common complication of lupus nephritis.

  5. Fatigue: Feeling tired or weak all the time.

  6. Loss of appetite: Not feeling hungry or having a decreased appetite.

  7. Weight gain: Unexplained weight gain may occur due to fluid retention.

  8. Skin rash: A butterfly-shaped rash on the face (both cheeks symmetrically affected) is a common sign of SLE, which can be associated with lupus nephritis.

  9. Joint pain: Pain and stiffness in the joints can be a symptom of SLE.

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If you have any of these symptoms, it is important to talk to your doctor, who may order tests to check your kidney function and determine if you have lupus nephritis. Early diagnosis and treatment can help to prevent further kidney damage and improve outcomes for patients.

What tests will my doctor perform to diagnose Lupus Nephritis

A combination of medical history, physical examination, laboratory tests, and kidney biopsy usually diagnoses lupus nephritis.

Medical history: Your doctor will ask you about your medical history, including any symptoms you are experiencing, family history of kidney disease or autoimmune disorders, and any medications you are taking.

Doctor and Patient

Physical examination: Your doctor will perform a physical examination to look for signs of kidney damage, rashes, ulcers, swelling, and cardiac abnormalities. 

Blood tests: Blood tests are performed to check for signs of inflammation, such as elevated levels of specific antibodies, and to evaluate kidney function, such as creatinine and blood urea nitrogen (BUN) levels. Creatinine is a waste product from the normal muscle breakdown in your body. Your kidneys remove creatinine from your blood. Creatinine estimates your glomerular filtration rate, which tells you how well your kidneys work.

 

Urine tests: Urine tests are done to check for the presence of protein, blood, or other substances that may indicate kidney damage.

Kidney biopsy: A kidney biopsy is a procedure in which a small sample of kidney tissue is taken and examined under a microscope to check for signs of inflammation and damage.

The results of these tests help your doctor determine the severity and type of lupus nephritis and develop a treatment plan.

Treatment of  Lupus Nephritis

Lupus nephritis is treated with a combination of medications and lifestyle changes. The goal of treatment is to control inflammation, preserve kidney function by blocking your body’s immune cells from attacking the kidneys, and prevent complications. Some common treatments for lupus nephritis:


Immunosuppressive medications: These medications are critically essential and help suppress the immune system and reduce kidney inflammation. They include corticosteroids, and immunosuppressive drugs, such as mycophenolate mofetil, cyclophosphamide, and azathioprine.


Blood pressure medications: High blood pressure is a common symptom of lupus nephritis and can further damage the kidneys. Medications to treat blood pressure and reduce proteinuria can help control blood pressure and protect the kidneys.


Diet and lifestyle changes: A low-salt, low-fat diet can help reduce blood pressure and control weight gain. Regular exercise can also help manage blood pressure and maintain overall health.


Dialysis or kidney transplant: In severe cases of lupus nephritis, dialysis or kidney transplant may be necessary to replace kidney function.


It's essential to work closely with your doctor to develop a personalized treatment plan for your specific needs. Regular follow-up appointments and laboratory tests are necessary to monitor kidney function and adjust treatment. With proper treatment and management, many people with lupus nephritis can maintain kidney function and live normal life.

Will I develop kidney failure if I have Lupus Nephritis?

The risk of developing kidney failure (also known as end-stage renal disease) due to lupus nephritis varies depending on the severity of the disease and how well it is managed. With proper treatment and management, many people with lupus nephritis can preserve kidney function and avoid kidney failure. However, in some cases, kidney failure may occur despite treatment.

The risk of kidney failure is higher in people with severe or active lupus nephritis, high blood pressure, high levels of protein in their urine, or impaired kidney function at the time of diagnosis. Patients with kidney failure secondary to SLE represent 1.5% of all patients on dialysis in the United States. Other factors that can increase the risk of kidney failure include a delay in diagnosis and treatment, poor adherence to treatment, and other medical conditions that can affect the kidneys. Patients with SLE account for 3% of all kidney transplantations in the United States. 

Regular follow-up appointments with your doctor and laboratory tests are necessary to monitor kidney function and adjust treatment as needed. Early diagnosis and prompt treatment of lupus nephritis can help reduce the risk of kidney damage and improve outcomes.

Clinical trials for Lupus Nephritis:

New treatments and therapies are being developed for kidney diseases. Ask your doctor if you want to participate in a clinical trial for Lupus Nephritis. More information is available on:  www.enrollmypatient.org 

Resources

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  • Connect with peers

  • Share experience

  • Raise awareness

  • Learn about clinical trials

  • Find studies close to you

  • Connect with centers conducting trials

Emerging Therapies

  • Medication under investigation

  • Latest research and clinical studies

  • Recently approved medications

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