Understanding Lupus and Kidney disease
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disorder that can affect any part of the body. When the kidneys are affected, it is known as lupus nephritis.
Lupus nephritis causes inflammation (swelling) of the small blood vessels that filter wastes in the kidney known as glomeruli, as well as other tissues of the kidneys. Long-term inflammation that is not treated leads to scarring of the kidneys.
Lupus nephritis is among the more serious complications of lupus, as the kidneys are responsible for removing waste products and toxins from the body, maintaining the correct balance of body fluids and regulating the hormones that help with blood pressure control.
It is estimated that about 50-60 per cent of persons with lupus have some degree of lupus kidney disease. Lupus nephritis most often develops within the first five years of lupus. It usually affects adult lupus patients between 20 and 40.
Additionally, lupus nephritis is a common way for paediatric lupus to initially present in Jamaica. Famous persons with lupus nephritis include actor Nick Cannon and singer Selena Gomez.
VERY FEW SIGNS IN EARLY STAGES
In the early stages of lupus nephritis, there may be no or very few signs that anything is wrong with the person's kidney. The first sign of lupus nephritis often shows up in laboratory testing of urine.
The most common symptoms and signs of the illness include:
- Protein in the urine, known medically as proteinuria. Inflammation in the kidneys can cause glomeruli to leak protein into urine. This is manifested by frothy or foamy urine.
- Blood in the urine, known medically as hematuria. Inflammation can also cause the glomeruli to leak blood into the urine. The urine may look pink or light brown from blood.
- Swelling of body parts, known medically as oedema. Extra fluid that the kidneys cannot remove leads to swelling in legs, ankles, and around your eyes.
- Weight gain: also due to the fluid retention.
- High blood pressure.
Tests that are ordered by rheumatologists and nephrologists to investigate for lupus nephritis and to better understand how it is affecting each individual patient include:
- Urine test to check for protein and blood
- Blood tests
- Check for glomerular filtration rate (GFR) to show how well the kidneys continue to filter waste products
- Check for levels of protein andcholesterol in the blood
* Check for anti-nuclear antibodies (ANA), double-stranded DNA (dsDNA), complement levels and antiphospholipid antibodies which help with diagnosis and monitoring of disease activity
- Kidney biopsy to look at a tiny piece of the kidney under a microscope
Lupus nephritis can be controlled with a number of medications, though there is no cure at this time.
Usually treatment for lupus nephritis includes:
- Corticosteroids and immunosuppressive drugs: These medications are used to dampen the immune system and stop it from attacking the kidneys.
- Prednisone is generally prescribed early on to stop inflammation.
- Immunosuppressive drugs may also be used with steroid therapy, such as cyclophosphamide, azathioprine, cyclosporin, mycophenolate mofetil and rituximab.
- ACE inhibitors and ARBs: Blood pressure medications used to reduce protein loss and control blood pressure.
- Diuretics: Medications which help the body to get rid of excess fluid and swelling.
- Diet changes: Reducing salt (sodium) and protein in the diet may reduce the waste the kidneys are required to filter.
Most patients with lupus nephritis who are identified early and comply with their treatment plan, as well as have regular check-ups do well long term.
If a patient's kidneys fail to respond to treatment and he or she goes on to develop end-stage renal disease (ESRD), the patient can be treated with dialysis or a kidney transplant.
Lupus patients do fairly well with these treatments when medications alone are no longer effective.