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Lupus and Chronic Kidney Disease

Lupus is one of the country's most common medical conditions, striking more Americans than cerebral palsy, multiple sclerosis, sickle-cell anemia, cystic fibrosis or AIDS. Yet, most people don’t know what it is. And even fewer know that half of all lupus patients develop kidney problems.

What is lupus?

Systemic lupus erythemotosus (SLE) or lupus is a chronic inflammatory disease. It causes the immune system to attack various systems of the body including the skin, heart, lungs, joints, nervous system, blood vessels and kidneys. It is called systemic because it can affect the whole body.

While a healthy immune system produces antibodies to fight against bacteria and other infections, an autoimmune disease like lupus prevents antibodies from working properly. With lupus, the antibodies are no longer able to tell the difference between harmful foreign substances and the body’s own healthy cells and tissue. As a result, the immune system “attacks” its own body parts, causing varying degrees of inflammation and organ damage.

The effects of lupus range from mild to severe. For example, it may affect the skin only, or it may affect multiple organs including the kidneys, which are the most commonly involved. To date, the cause of lupus is unknown; however it has been linked to heredity and environmental factors.

Other types of lupus

While the broad term "lupus" usually refers to systemic lupus erythematosus (SLE), there are two additional, milder forms of the disease known as discoid and drug-induced lupus.

Discoid (cutaneous) lupus primarily affects the skin, but may also involve the hair and mucous membranes. It is identified by a rash that appears on the face, neck, or scalp. This rash may last for days or years, and may also disappear and recur later.

Drug-induced lupus is triggered by certain prescribed medications, but usually goes away when the medicine is stopped. Two drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension) and procainamide (used to treat irregular heart rhythms). Drug-induced lupus is more common in men; however, only about 4% of the people who take these drugs will develop lupus.

Who gets lupus?

Because it primarily targets women in their childbearing years, lupus is known as a “woman’s disease.” It also occurs more often in minorities.

Here are some quick facts about who gets lupus:

Symptoms

No two lupus patients will have identical symptoms. However, there is a common list of symptoms and complaints that include:

  • joint aches
  • low-grade fever
  • arthritis
  • fatigue
  • facial "butterfly” rash
  • unusual sensitivity to sunlight
  • loss of appetite
  • ulcers of the mouth and nose
  • poor circulation in the fingers and toes with cold exposure (called Raynaud's phenomenon).

Many of these symptoms will disappear and recur later. Also, most people with lupus do not experience all of the symptoms listed.

In discoid lupus, patients often develop a skin rash on the face, neck or scalp. It is usually red and may have raised borders. Discoid lupus rashes are generally painless and do not itch, but scarring can cause permanent hair loss. Over time, 5 to 10% of patients with discoid lupus may develop systemic lupus.

How is lupus diagnosed?

Since many lupus symptoms come and go, and often mimic those of other diseases, lupus can be difficult to diagnose. There is currently no single lab test to definitively determine that a person has lupus. Instead, diagnosis is made by looking at a patient’s medical history, physical exam results and specialized lab test results for immune status.

One of these specialized tests is the antinuclear antibody (ANA) test. While this test does play a key role in diagnosis, it is important to note that a positive ANA result does not always mean a person has lupus. About 20% of people will test positive for ANA. In addition, other conditions like thyroid disease, certain liver conditions and other autoimmune diseases will produce positive ANA test results.

Before making a diagnosis of lupus, physicians should be able to find objective physical or laboratory evidence of the condition, such as swelling of the joints, protein in the urine, fluid around the lungs or heart or a positive skin biopsy.

How lupus affects the kidneys

The kidneys are especially vulnerable for people with lupus. Varying degrees of inflammation caused by the disease can result in lupus nephritis and even kidney failure.

Lupus nephritis is the medical term for kidney disease that occurs in SLE patients. With this disease, the tiny filters in the kidneys are damaged resulting in a loss of kidney function. This may lead to fluid retention with weight gain and swelling, called edema. Puffiness in the legs, ankles and/or fingers is often the first complaint of lupus nephritis patients. Other than edema, there are very few signs or symptoms. Lupus nephritis does not produce pain in the abdomen or back, or burning during urination.

It’s important to be aware that not all kidney problems in lupus patients are caused by lupus nephritis. Urinary tract infections occur frequently in lupus patients and require antibiotic treatment.

Similarly, medications used for treating lupus may produce signs of kidney disease that could be confused with lupus nephritis. For example, salicylate compounds, like aspirin, or non-steroidal anti-inflammatory drugs, like ibuprofen, are commonly used by lupus patients and can cause loss of kidney function or fluid retention. These problems usually fade when the medications are discontinued.

Treatment

While there is no cure, there have been major advances in the treatment of lupus nephritis in recent years.

Medications

Depending on the severity of disease and the specific organs involved, medications can be used to decrease swelling, lower blood pressure and decrease inflammation by suppressing the immune system. These medications range from over the counter pain relievers like ibuprofen and aspirin, to prescription drugs like prednisone, azathioprine, cyclophosphamide or cyclosporine, which block the production of specific antibodies. Recently mycophenolate mofetil has also been used to treat severe lupus nephritis.

Diet

Patients may need to limit protein, sodium and potassium in their diets; however, maintaining a well-balanced diet is very important. Scientists have found that antibodies and other immune system cells may be adversely affected by nutritional deficiencies. Therefore, it is best to avoid fad diets that advocate either an excess or an exclusion of certain types of foods.If any diet modifications are necessary, the physician will let the patient know and make a referral to a dietitian for individualized medical nutrition therapy.

Lifestyle changes

Patients with lupus should make lifestyle changes like staying out of the sun, wearing sunblock and avoiding stress. Getting enough sleep, along with regular exercise, helps prevent muscle weakness and fatigue. Support groups and counseling can help alleviate stress.

In addition, lupus patients are advised to avoid smoking and drinking excessive amounts of alcohol and to get regular medical checkups.

Dialysis and kidney transplant

Despite appropriate treatment, some patients with lupus nephritis will develop chronic kidney disease that could lead to renal failure. End stage renal disease caused by lupus can be treated with dialysis or a kidney transplant with the same kind of success as kidney failure caused by other types of disease.

Conclusion

With better diagnostic techniques and treatments available today, the prognosis of lupus and lupus nephritis is much better than ever before. Lupus patients who get involved with their care by visiting their physician regularly, taking their medications as prescribed and leading a healthy lifestyle can enjoy a much improved quality of life.

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