Things You Should Know About Kidney Disease And Lupus
Studies revealed that about a third of patients that have systemic lupus erythematosus can develop a kidney disease called lupus nephritis or lupus glomerulonephritis.Lupus nephritis usually shows very few signs. It doesnt cause pain or burning during urination and also it does not produce pain in the abdomen or back.The first symptom the patient with lupus nephritis usually experiences is puffiness in the legs, ankles or fingers. This happens because the loss of protein in the urine may lead to fluid retention with weight gain and swelling.
Sometimes the fact that a patient has lupus nephritis is discovered only after urine studies are made. It is very possible that if there is made another urine test, the urine abnormalities to disappear. But there are patients in which the abnormal findings on urine studies persist or can become even worse in time. This kind of patients require more studies to determine the best treatment to control the disease, because there appears the risk for loss of kidney function.
It is important to know that patients having lupus can experience some symptoms that confuse them and think they have lupus nephritis. For example infections of the urinary tract with burning on urination, or medications used in lupus treatment may produce signs that can start the confusion.There are some tests that can be done in order to find out if a patient has lupus nephritis.
Urinalysis is the most used and the most simple test to do. A urine sample is studied to find out if there is protein and blood cells which are not normally found in the urine.If in the urine sample there are found red blood cells, white blood cells, casts(excretion in the urine of protein or blood cells that collect within the tubules of the kidney), or there is discovered the presence of protein, there exists the possibility of lupus nephritis, and further tests are necessary.Sometimes, it is done a urine collection over a period of 24 hours to measure the kidneys ability to filter waste products.
Blood studies can also be performed, and we can mention the blood urea nitrogen and serum creatinine. These are tests that are made to find out if waste products are being removed properly by the kidney and are not building up in the blood.By measuring the serum albumin, it can be determined if there is a low protein level in the blood, and chemistry studies such as the serum sodium, potassium, and bicarbonate determine the imbalances of salt and water in the blood.There can be also made blood tests in order to determine if there are abnormalities of the immune system.
An intravenous sonogram or pyelogram can be made to determine the size and shape of the kidneys. Usually this test takes place before a kidney biopsy.The kidney biopsy takes place in order to confirm the diagnosis of lupus nephritis. It is made by inserting a needle through the skin of the back and removing a tiny piece of the kidney.Then, the small part taken from the kidney is analyzed under the microscope in order to determine how much inflammation or permanent damage is present within the kidney.
There are four most common types of nephritis: focal or diffuse proliferative nephritis, mesangial nephritis and membranous nephritis.
The treatment for lupus nephritis must be individualized, because there are different patients having different needs. It is important that all factors that appear to be taken in consideration when deciding the treatment.General principles of medical management of kidney disease include anti-hypertensive drugs to control increased blood pressure, diuretic agents to help eliminate excess fluid, changes in the diet to control the intake of salt, proteins and calories. These are very important in lupus nephritis.
Corticosteroids are often used to treat lupus nephritis. We can mention here prednisolone, prednisone and methylprednisolone. There still are some unanswered question about how corticosteroids work and how they may be most effectively used. Usual, high doses of corticosteroids are given until there appears improvement in the lupus nephritis. Then , the dose is reduced, but there is done a careful observation by the physician to make sure that the nephritis doesnt get worse.If corticosteroids are given for long periods, there can appear side effects, like easy bruising, increase in appetite and fluid retention with weight gain, cataracts, thinning of the hair, an increase in the risk of infection, diabetes and other.
When patients do not respond at corticosteroid treatment, they are given Cytotoxic or immunosuppressive drugs such as azathioprine or cyclophosphamide. The effect of these drugs is to block the function of the immune system.As a result, further damage to the kidneys is prevented. However, even if these drugs may be beneficial, they can also bring serious complications.
Although there is appropriate treatment, there are patients that develop progressive loss of kidney function and renal failure. This requires the use of artificial dialysis, and that can be done by hemodialysis or peritoneal dialysis.Also, it can be made a kidney transplantation, and it is known that this has been very successful in patients with renal failure from lupus nephritis.
Over the years, science advanced in the understanding of what causes lupus nephritis, and there were made improvements in ways to treat patients.