Kidney and rheumatic diseases - Lupus nephritis

Systemic Lupus erythematosus (SLE) relates to kidney disease, since "lupus nephritis” is a type of kidney disease caused by SLE. 30-50% of patients with SLE may experience renal function deterioration.

  • Is there a specific test for the diagnosis of lupus nephritis?
  • No, there is no specific test for lupus nephritis. There are tests that raise suspicion for a patient suffering from SLE such as:
  • • a simple general urinalysis
  • • a microscopic examination of urine
  • • a urine albumin test
  • • a test for urea and creatinine concentration 
  • When suspicion is evident, you may need to perform a kidney biopsy. Kidney biopsy will give us information about the disease, how "active" it is and the "chronic" damage it has been done.
  •  
  • What are the symptoms?
  • It often occurs without symptoms. Symptoms may only occur if there is severe renal insufficiency. 80% of patients with renal insufficiency may show signs of hematuria (blood in urine visible only in general urinalysis), 80-100% of patients may show signs of urinary albumin (protein), 30-40% of patients may develop hypertension, whereas 20% of patients may experience some degree of renal dysfunction.
  •  
  • How does Lupus affect the renal system?
  • There are 6 forms of kidney damage depending on different laboratory results and prognosis, and due to that (apart from diagnosis) the kidney biopsy it is important to determine which of the forms the patient experiences. It is very important for the choice of treatment and for the understanding of the prognosis to know which one of the different forms of lupus nephritis we experience, when the disease is active and at which degree the damage is chronic and irreversible.
  •  
  • Is there a treatment for lupus nephritis?
  • Yes, with the goal of the clinical remission of the disease, e.g. there are no urine findings (hematuria, albuminuria) or if they exist they should be only a few. Another goal is to avoid relapses and of course to avoid toxicity of the treatment. The treatment is differentiated according to the laboratory findings, the biopsy findings, and the level of renal function. There are many medications and therapies that the physician can choose based on the clinical picture, the biopsy and the level of kidney function.
  •  
  • What is the purpose of the treatment and which drugs can be used for lupus nephritis?
  • The primary goal of the treatment (with induction therapy lasting 3-6 months) is to "reduce" the function of the defense system so that it stops attacking the patient's kidney. With this action, the aim is to delay the renal damage due to SLE, and the medicines used for this purpose are cortisone (almost a "permanent" drug in the treatment of lupus nephritis), immunosuppressants (such as cyclophosphamide), rituximab human / human monoclonal antibody that is produced by genetic engineering technology and is a part of the new treatments for lupus nephritis. Once the disease activity has been controlled, maintenance therapy is initiated for patients who improve their hematological clinical condition, reduce albuminuria and improve renal function. Its goal is to prevent relapse of the disease after induction therapy. Corticoids are used again (at lower doses), but in this case immunosuppressants such as azathioprine or mycophenolate mofetil. Naturally, in the context of treatment, the treatment of hypertension should also be included which may occur with SLE.
  •  
  • I am a young woman diagnosed with SLE. Will it affect my pregnancy?
  • Read the following article for more information - Pregnancy in women who suffer from SLE and Lupus nephritis
  •  
  • How does a lupus diagnosis affect my life?
  • Some changes in dietary habits and lifestyle must be made to protect the kidney to some extent. Thus, the patient with lupus nephritis must:
  • • be sufficiently hydrated continuously
  • • avoid smoking
  • • follow a diet with low salt content
  • • exercise daily
  • • take tests for all risk factors for vascular disease (hypertension, cholesterol, obesity)
  • • avoid non-steroidal anti-inflammatory diseases
  •  
  • Mesogeios Dialysis Centers Group Scientific Team 
  •  
  • Bibliography
  • 1.Kattah AG, Garovic VD. Pregnancy and Lupus Nephritis. Semin Nephrol. 2015 Sep;35(5):487-99. doi: 10.1016/j.semnephrol.2015.08.010. Review. PubMed PMID: 26573551.
  • 2.Kiremitci S, Ensari A. Classifying lupus nephritis: an ongoing story. ScientificWorldJournal. 2014;2014:580620. doi: 10.1155/2014/580620. Epub 2014 Dec 8. Review. PubMed PMID: 25548784; PubMed Central PMCID: PMC4274910.
  • 3.Beckwith H, Lightstone L. Rituximab in systemic lupus erythematosus and lupus  nephritis. Nephron Clin Pract. 2014;128(3-4):250-4. doi: 10.1159/000368585. Epub  2014 Nov 29. Review. PubMed PMID: 25471633.
  • 4.Liu Y, Anders HJ. Lupus nephritis: from pathogenesis to targets for biologic treatment. Nephron Clin Pract. 2014;128(3-4):224-31. doi: 10.1159/000368581. Epub 2014 Nov 8. Review. PubMed PMID: 25401461.
  • 5.Schwartz N, Goilav B, Putterman C. The pathogenesis, diagnosis and treatment of lupus nephritis. Curr Opin Rheumatol. 2014 Sep;26(5):502-9. doi: 10.1097/BOR.0000000000000089. Review. PubMed PMID: 25014039; PubMed Central PMCID: PMC4221732.
  • 6.Lorenz G, Desai J, Anders HJ. Lupus nephritis: update on mechanisms of systemic autoimmunity and kidney immunopathology. Curr Opin Nephrol Hypertens. 2014 May;23(3):211-7. doi: 10.1097/01.mnh.0000444816.57378.21. Review. PubMed PMID: 24662982.
  • 7.Rovin BH, Parikh SV. Lupus nephritis: the evolving role of novel therapeutics. Am J Kidney Dis. 2014 Apr;63(4):677-90. doi: 10.1053/j.ajkd.2013.11.023. Epub 2014 Jan 7. Review. PubMed PMID: 24411715; PubMed Central PMCID: PMC4159074.
  • 8.Anders HJ, Fogo AB. Immunopathology of lupus nephritis. Semin Immunopathol. 2014 Jul;36(4):443-59. doi: 10.1007/s00281-013-0413-5. Epub 2014 Jan 9. Review. PubMed PMID: 24402709.
  • 9.Maroz N, Segal MS. Lupus nephritis and end-stage kidney disease. Am J Med Sci. 2013 Oct;346(4):319-23. doi: 10.1097/MAJ.0b013e31827f4ee3. Review. PubMed PMID: 23370533.
  • 10.Hogan J, Appel GB. Update on the treatment of lupus nephritis. Curr Opin Nephrol Hypertens. 2013 Mar;22(2):224-30. doi: 10.1097/MNH.0b013e32835d921c. Review. PubMed PMID: 23328501.
  •  
  • 11.Borchers AT, Leibushor N, Naguwa SM, Cheema GS, Shoenfeld Y, Gershwin ME. Lupus nephritis: a critical review. Autoimmun Rev. 2012 Dec;12(2):174-94. doi: 10.1016/j.autrev.2012.08.018. Epub 2012 Sep 8. Review. PubMed PMID: 22982174.

 

Κορυφή