Lupus Nephritis Diagnosis And Treatment
The diagnosis of lupus nephritis begins with a medical history, physical exam, and evaluation of symptoms. You doctor will likely order tests to make or confirm a diagnosis. Tests used in diagnosing kidney problems include urine tests, blood tests, imaging tests such as ultrasound, and kidney biopsy.
There are five different types of lupus nephritis. Treatment is based on the type of lupus nephritis, which is determined by the biopsy. Since symptoms and severity vary from person to person, treatments are individually tailored to meet a person’s particular circumstances.
Medications used in treatment can include:
- Corticosteroids. These strong anti-inflammatory drugs can decrease inflammation. Doctors may prescribe these until the lupus nephritis improves. Because these drugs can cause a variety of potentially serious side effects, they must be monitored carefully. Doctors generally taper down the dosage once the symptoms start to improve.
- Immunosuppressive drugs. These drugs, which are related to the ones used to treat cancer or prevent the rejection of transplanted organs, work by suppressing immune system activity that damages the kidneys. They include azathioprine , cyclophosphamide , voclosporin and mycophenolate .
- Medications to prevent blood clots or lower blood pressure if needed
Ultimately, it may be necessary to have a kidney transplant. In those cases, people will need additional drugs to keep their immune system from rejecting the transplanted kidney.
Lupus And Kidney Management
The overall goal of treating lupus nephritis is to normalize your kidney function and prevent further damage. Your healthcare provider will teach you strategies to manage your symptoms, and they will prescribe medications.
Lupus nephritis is treated with medications that reduce inflammation and suppress the immune system. These medications include corticosteroids like prednisone and immunosuppressive drugs like cyclophosphamide.
Sometimes people with lupus nephritis also have high blood pressure. Your healthcare provider may give you blood pressure lowering medications like angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to prevent further damage to your kidneys.
If you are diagnosed with lupus nephritis, you should avoid over the counter NSAID medications like ibuprofen, aspirin, diclofenac and naproxen because these can harm your kidneys.
Who Gets Lupus Nephritis
Only adults and children with lupus can develop lupus nephritis. Youre more likely to get lupus if you:
- Are a woman between the ages of 15 and 44, though men are more likely to develop lupus nephritis.
- Are of Black, Native American, Hispanic/Latino, Pacific Islander or of Asian descent.
- Come in contact with certain infections, viruses, toxic chemicals or pollutants in the environment.
- Have a family history of the disease.
- Have another autoimmune disease.
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Treatment Of Lupus Nephritis
Lupus nephritis is typically treated by managing its symptoms through medication and diet. Treatment focuses on reducing inflammation and treating the underlying cause of lupus. Some patients may require treatment to restore normal kidney function, and reduce the risk of permanent damage. Treatment includes the following:
- Limiting salt and protein in the diet
- Taking medication to control high blood pressure
- Taking immunosuppresive medication
- Taking anti-inflammatory medication
In some cases, dialysis may be needed temporarily to provide adequate kidney function. Severe cases may require a kidney transplant.
What Are The Signs Of Kidney Lupus How Is It Diagnosed And Classified
Swelling of the ankles and abdomen may be a sign of kidney disease, but the problem with kidney lupus is that often people are not aware that it is occurring until they visit the doctor for lab tests and blood work. Testing for the disease includes urinalysis, which your doctor will check for items such as red blood cells, red blood cell casts, and protein that has leaked from your kidneys into your urine. In addition, she/he will most likely ask you to perform a 24-hour urine test and determine the efficiency with which your kidneys are filtering blood by measuring your creatinine clearance. Lastly, your doctor may also recommend you to a kidney doctor to perform a biopsy to determine the class and degree of your kidney involvement. There are 6 levels of kidney lupus and the class in which your disease falls will help your doctor to design a specific course of treatment.
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How Might Lupus Affect The Kidneys
Lupus can affect the kidneys in several ways. Most people are unaware of this and we therefore need to test the urine for the presence of protein that shouldnt be there. We also test the blood for abnormal kidney function.
The most common finding is protein in the urine, which is due to leakiness in the kidney caused by inflammation. If the protein in the urine is very high, in order of several grams a day, it can lead to a drop of protein levels in your blood.
It causes you to develop swelling in your ankles and legs when standing and moving, as well as developing a puffy face. Inflammation of the kidneys is generally called lupus nephritis and in different patients we have specific ways of diagnosing it depending on the individuals symptoms.
How Do Doctors Treat Lupus Nephritis
Health care professionals treat lupus nephritis with medicines that suppress your immune system so it stops attacking and damaging your kidneys. Goals of treatment are to
- reduce inflammation in your kidneys
- block your bodys immune cells from attacking the kidneys directly or making antibodies that attack the kidneys
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Lupus And Kidney Complications
Most of the time, swift and effective treatment can control lupus nephritis and reduce your risk of complications. However, not everyone responds to treatment.
The most severe form of lupus nephritis, diffuse proliferative nephritis, commonly leads to kidney failure. About 10 to 30 percent of patients with lupus nephritis later develop kidney failure.
Kidney failure is also called end-stage renal disease, and it requires aggressive treatments like dialysis or a kidney transplant.
People diagnosed with lupus nephritis are also at risk for developing B-cell lymphoma, a type of cancer that begins in the cells of the immune system.
Systemic lupus erythematosus is a disease where the body attacks its own healthy tissues. Lupus nephritis occurs when the body attacks the kidneys. The cause of SLE remains unclear.
How Is Lupus Nephritis Treated
Medication and diet changes are the most common treatments for lupus nephritis. Your healthcare provider may recommend:
- Blood pressure medication: Angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers help control blood pressure and reduce protein loss.
- Corticosteroids and immunosuppressive drugs: These medications prevent your immune system from attacking the blood vessels in your kidneys.
- Diet changes: You may need to reduce your sodium intake. Eating less protein, such as meat and dairy, can also make it easier for your kidneys to work. Work with your healthcare provider and a dietitian to build a healthy diet tailored to your needs.
- Diuretics: These medications help treat edema . Diuretics can also lower your blood pressure.
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How Will I Know If I Have Lupus Nephritis
Only people who have lupus can have lupus nephritis. If your health care provider thinks that your lupus might be affecting your kidneys, they might order urine tests to look for blood or protein in your urine. Having blood or protein in your urine can be a sign that your kidneys are not working as well as they should. Your health care provider might also want to give you a blood test to check for the level of creatinine in your blood. Creatinine is a waste product caused by muscle activity. Having a high level of creatinine in your blood is also a sign that there is a problem with your kidneys.
If your blood and urine tests show that there might be a problem, your health care provider might want you to have a kidney biopsy to look for signs of lupus nephritis. A kidney biopsy is a procedure where your doctor takes a tiny piece of your kidneys to look at it closely under a microscope. Your doctor checks it for signs of lupus nephritis, such as inflammation or scarring.
Your health care providers may not always know if you have lupus nephritis right away. Symptoms of lupus nephritis can also look like symptoms of other diseases. It may take up to several years for you to get the right tests or diagnosis.
What Resources Are Available That Can Help People Cope With Having Lupus Nephritis
A lupus diagnosis can come as a shock. It is a disease that many people do not know much about. Getting the right diagnosis is the first step to getting the care you need. Because lupus is a lifelong disease, it can impact your daily routine in different ways for the rest of your life. Physical symptoms, frequent doctor visits and financial stress can all impact your emotional well-being. Your mental health is just as important as your physical health if you are living with lupus or lupus nephritis.
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An Important Note About Medications And Blood Pressure
Due to the silent nature of kidney lupus, it is very important that you take your medications daily as prescribed by your doctor. Even if you do not feel sick, inflammation in your kidneys and other organs can lead to permanent, irreversible scarring. Your medications can combat this inflammation right now, but permanent scarring will never go away. If kidney disease is allowed to progress without treatment, your kidneys will fail, and you will need to go to dialysis three times per week to have your blood filtered. The only way to get off dialysis is to have a kidney transplant, and organ transplant opportunities are not easy to come by. This information is not meant to frighten you, but merely to ensure that you understand how important it is to take your medications!
In addition, since the kidneys are tied intimately to the regulation of your blood pressure, it is imperative that you maintain a healthy blood pressure of 120/80 mmHg. If your doctor prescribes a blood pressure medication to keep your kidney lupus in check, be sure to take it exactly as prescribed. Limit your intake of salt to less than 3 grams per day, and try to eat a healthy, well-balanced diet. The prognosis for people with lupus nephritis does not have to be grim it is important to remember that you play the most important role in keeping your body as healthy as possible!
What Does Lupus Do To The Body Especially To The Kidneys Find Out
What does lupus do to the body? Is it particularly dangerous for the kidneys? What can you do about it? Find out all the answers!
Lupus can manifest itself in many different ways, from a skin rash to joint involvement or kidney damage.
Lupus is a fairly complex chronic autoimmune disease. It consists of the immune system attacking the tissues of your own body, causing an inflammatory process. It can affect anywhere, such as the skin, joints, or kidneys.
Unfortunately, the incidence of lupus has increased in recent years. It is estimated that it affects 9 out of every 10,000 inhabitants in Spain. The problem is that this disease can manifest itself in many different ways, so diagnosing it is sometimes complex.
Although many people are unaware of it, the kidneys are one of the organs most damaged by this pathology. In this article we explain how lupus affects the kidneys and what consequences it can have.
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How Long Is The Wait For A Kidney Donor Organ
Kidney transplants are the most common transplant in the U.S. by far, so competition for these organs is great.4
If you do not have a friend or family who is a willing and suitable donor, the wait for a kidney from the national list can take 3 to 5 years. How long you wait depends on several factors, including your blood type, antigens, and the organ size needed.5-6
What Role Does A Pathologist Play In Diagnosing And Managing Lupus
Lupus has a wide range of symptoms, many of which mimic other conditions. As with other autoimmune diseases, diagnosis can be tricky.
The clinician can look at a patients symptoms and laboratory tests and say, I think this patient has lupus nephritis, but the kidney biopsy, which is the definitive test, is done in the pathology department, Dr. Moeckel says.
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How Is Lupus Diagnosed
Lupus nephritis is suspected when blood or protein is found in the urine. Another test that can indicate a problem is when the serum creatinine level in your blood is abnormally high. This can result in a decreased Glomerular Filtration Rate . Doctors estimate how well your kidneys are functioning using this test. Your doctor then might refer you to a nephrologist for a kidney biopsy. A biopsy is the only test which can diagnose lupus nephritis.
Once you have a biopsy, the sample is then identified based upon the degree and pattern of swelling and damage. This is shown in the table below. There are six classes of the disease. The severity of your disease is used by your kidney doctor or rheumatologist to make decisions with you about treatment options.
Table 1: The 2003 International Society of Nephrology and International Pathology Society Classification of lupus nephritis
- Class I: Minimal mesangial lupus glomerulonephritis
- Class II: Mesangial proliferative LGN
- Class III: Focal LGN
- Class IV: Diffuse LGN
- Class IV-S: Predominantly segmental
Why are these classes important?
Who Is At Risk For Lupus Nephritis
An estimated 1.5 million Americans have a type of lupus. About 1 in 2 adults with lupus will have lupus nephritis. The two main risk factors for lupus nephritis are sex and race or ethnicity.
- Although 90% of people who have lupus are female, males have a higher chance of getting lupus nephritis than females.
- Racial/ethnic minorities, such as African Americans, Hispanics, and Asian Americans, also have a higher chance of getting lupus nephritis.
People who have a family member with lupus nephritis are also at a higher risk. If you have a family member with lupus, you should share this information with your doctor and ask if you need to be tested. Many experts believe the cause of lupus is a combination of genetic and environmental factors. For example, having the APOL-1 gene can increase your risk of developing kidney disease and lupus nephritis.
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Targeting Endothelial Cell Dysfunction
An improved understanding of the mechanisms of endothelial dysfunction and hypoxia may lead to novel therapies. Endothelial glycocalyx deterioration may be prevented by angiotensin 2 inhibition and mycophenolate can inhibit PDGF-B production . ACE inhibitors also reduce endothelial activation by increasing NO production independently of their anti-hypertensive effects . Podocytes lacking both endothelin receptors are protected from damage in animal models of diabetes and an endothelin antagonist reduced proteinuria in patients with diabetic nephropathy . Targeting of VEGF-A or PDGF has proved more challenging because the relationships between angiogenesis, inflammation and fibrosis are still not fully understood. For example, some proangiogenic factors also enhance inflammation or fibrosis and PDGF may be involved in tubular regeneration . In addition angiogenesis may be detrimental early in disease, helping to mediate glomerular hypertrophy, before becoming dysfunctional at later stages .
Choosing To Undergo A Kidney Transplant
A kidney transplant operation is a very personal and difficult choice. Transplants can be very expensive, even with insurance. Insurance likely will not cover most non-medical expenses associated with a transplant, such as:
- Relocating to live close to a transplant center
- Living expenses if you cannot work
- Transportation to and from the transplant center.
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What Are The Symptoms Of Lupus
The most common symptoms include:
- A rash on your face
- Sun sensitivity
- Joint pain, in the small joints of the hands and feet which is worse in morning
- Hair loss in patches or in large amounts in some people
- In some cases, there can be pain when breathing
- Feeling overwhelmingly tired, which is not often realised to be part of something bigger
How Is Kidney Lupus Monitored
As you return to your doctors office, she/he will most likely keep close watch on your kidneys to ensure that your kidney involvement is not worsening. There is no all-encompassing test for kidney function instead, your doctor will use a number of tests to monitor your blood and urine. By obtaining a blood urea nitrogen levels and blood creatinine levels, she/he can monitor how well your kidneys are filtering blood. In addition, you blood pressure will be monitored, since high blood pressure is an indication of kidney degeneration. High levels of protein in the urine can indicate increased kidney involvement, since protein usually does not cross from your blood vessels into your kidney tubules and thus should not appear in your urine. In addition, tests of blood complement and anti-DNA antibodies can suggest inflammation that may be affecting the kidneys.
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Initiation Of Inflammation By Immune Complexes
LN is initiated in most cases by the glomerular deposition of IgG and complement. Rarely, LN occurs in the absence of immune complexes, presumably due to direct damage by soluble inflammatory mediators . Sources of immune complexes include circulating anti-nuclear, anti-C1q, and crossreactive anti-glomerular autoantibodies , opsonized apoptotic particles, microparticles, and neutrophil NETs . Particulate DNA such as that within neutrophil NETs can be resistant to digestion by DNAse , and downregulation of renal DNAse I can be a late feature of disease . Although antibodies eluted from LN kidneys are enriched for anti-DNA activity, not all anti-DNA antibodies are pathogenic. Furthermore, non-DNA binding antibodies, some arising in situ, also contribute to renal disease . This heterogeneity of renal depositing antibodies limits the ability of serum antibody profiles to predict LN flares .