Living with Lupus Nephritis

Lupus nephritis is a significant and serious disorder that often affects individuals with systemic lupus erythematosus (SLE), commonly known as Lupus. Lupus, an autoimmune disease, causes the body’s immune system to attack its cells and organs, including the kidneys. This attack results in a type of kidney disease called lupus nephritis, which can progress over time and potentially lead to kidney failure.

What is Lupus Nephritis?

Lupus nephritis occurs when lupus autoantibodies target parts of the kidneys responsible for filtering waste. This autoimmune attack leads to inflammation, swelling, and irritation of the kidneys. Key symptoms include:

• Blood in the urine
• Protein in the urine (foamy urine)
• High blood pressure
• Swelling in various parts of the body (hands, face, belly, legs, ankles, feet).
• High levels of creatinine in the blood
• Reduced urination
• Extreme fatigue

The American College of Rheumatology (ACR) classifies this disorder based on specific criteria such as proteinuria (protein in the urine) and the presence of urinary cellular casts.

Who is at Risk?

Both children and adults with lupus can develop lupus nephritis. However, certain groups are more prone to this condition:

• While women between the ages of 15 and 44 are more likely to develop lupus, men are more likely to develop lupus nephritis.
• People of Black, Native American, Hispanic/Latino, Pacific Islander, or Asian descent are at a higher risk.
• Exposure to specific infections, viruses, toxic chemicals, or environmental pollutants can increase susceptibility.
• A family history of lupus or other autoimmune diseases can also elevate the risk.

Diagnosing Lupus Nephritis

To diagnose this disorder, doctors utilize a combination of urine and blood tests, along with a kidney biopsy:

• Urine Test: A high amount of protein or a high number of red blood cells in the urine indicates kidney damage. Microscopic examination of the urine looks for kidney cells.
• Blood Test: Checking the levels of creatinine and eGFR to measure kidney function. Other tests may include checking for specific antibodies such as anti-phospholipids and anti-nuclear antibodies (ANA).
• Kidney Biopsy: For determining the extent of the disease and confirming the diagnosis.

Treatment Options

The main aim of treating lupus nephritis is to decrease inflammation and calm down the immune system to protect the kidneys from more damage. Common treatments include:

• Corticosteroids: Often prednisone, to reduce swelling and inflammation.
• Immunosuppressive Drugs: Such as cyclophosphamide or mycophenolate mofetil, which help to suppress the overactive immune response.
• Hydroxychloroquine: This medication is specifically used for systemic lupus erythematosus (SLE) to manage symptoms.
• Blood Pressure Medications: These include ACE inhibitors, ARBs, diuretics, beta-blockers, and calcium channel blockers, which help manage high blood pressure, a common complication of this autoimmune disease.

Dietary Recommendations

Managing lupus nephritis involves paying attention to diet. Patients are typically encouraged to limit their sodium intake to help manage blood pressure. It’s beneficial to collaborate with a dietitian to create a nutritious eating plan that promotes kidney health.

Please go through blog below to know more about the impact of excess salt on kidney health 👇👇

Join our Renal diet WhatsApp group for personalized diet consultation 👇👇

Potential Complications

Without proper diagnosis and treatment, this disorder can lead to severe complications, including kidney failure. Approximately 10 to 30 percent of individuals with this disorder may develop kidney failure, requiring dialysis or a kidney transplant. Other potential complications include increased risks of cancer (especially B-cell lymphoma) and cardiovascular problems.

Pregnancy and Lupus Nephritis

Women with this disorder face higher risks during pregnancy, including preeclampsia, premature labour, and lupus flares. Monitoring and managing this disease carefully during pregnancy is crucial for the health of both the mother and the baby. Lets know more about the possibilities of pregnancy with kidney disease from the following blog 👇👇

Living with Lupus Nephritis

Effectively managing this disorder involves consistently taking medications, making lifestyle adjustments, and attending regular medical appointments. Patients must maintain close communication with healthcare providers to monitor their condition closely and make any necessary treatment modifications.

References:

1. Madhok R. Systemic lupus erythematosus: lupus nephritis. BMJ Clinical Evidence. 2015 Dec 18:pii:1123.
2. Diagnosis and classification of renal disease in systemic lupus erythematosus. UpToDate website. Updated March 24, 2016. Accessed October 19, 2016.
3. Hahn BH, McMahon M, Wilkinson A, et al. American College of Rheumatology guidelines for screening, treatment and management of lupus nephritis. Arthritis Care & Research. 2012;64(6):797–808.
4. National Kidney Foundation: Lupus Nephritis
5. Cleveland Clinic: Lupus Nephritis
6. Rina Musa; Lawrence H. Brent; Ahmad Qurie. 2023. Lupus Nephritis; Treasure Island (FL): StatPearls Publishing