What Is Lupus Nephritis?
Lupus is an autoimmune disease. The autoimmune disease makes the immune system attack the healthy cells. The immune system is known to protect the body against the disease, but the immune system turns against the body's own cells in case of any autoimmune disease. Lupus can affect any part of the body. There are two types of lupus:
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Systemic lupus erythematosus (SLE).
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Discoid lupus erythematosus.
Systemic lupus erythematosus (SLE) is a type of lupus that affects the skin, joints, kidneys, and brain, whereas discoid lupus erythematosus affects only the skin. So when the kidneys are affected, it is called lupus nephritis. In lupus nephritis, there is swelling of the blood vessels that filter the waste products. The most severe form of lupus nephritis is proliferative nephritis resulting in permanent damage to the kidneys.
What Are the Causes of Lupus Nephritis?
The exact cause of lupus nephritis is unknown. It is considered that family history or any infection or pollutants can play a role in causing lupus nephritis. Experts believe that a combination of genetic and environmental factors can be a cause of lupus.
Who Is More Likely to Develop Lupus Nephritis?
Lupus nephritis is most commonly seen in women rather than in men. Nine out of ten people with lupus nephritis are women. About one in two adults with lupus will have kidney disease. People who have a family history of lupus are also at a higher risk of developing lupus nephritis.
What Are the Symptoms of Lupus Nephritis?
Lupus nephritis has the following symptoms:
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Frequent urination, especially during the night.
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Weight gain.
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Joint pain.
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Joint swelling.
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Foamy urine.
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Blood in the urine.
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Swelling of the legs, feet, ankles, and in a few cases, there can be swelling of the hands and face.
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Muscle pain.
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Red rashes on the face.
How Is Lupus Nephritis Diagnosed?
To diagnose lupus, the doctor will suggest getting an antinuclear antibody (ANA) test. The presence of these antibodies indicates that there is something wrong with the immune system, but it does not definitely diagnose lupus, as most people with a positive ANA test do not have lupus. A person who tests positive for ANA is then asked to get an anti-dsDNA (anti-double stranded DNA) test, which is more specific.
One of the hallmark signs of lupus nephritis is blood in the urine or foamy urine. High blood pressure and swelling of the feet, legs, and ankles can also indicate lupus nephritis. Henceforth doctors diagnose lupus nephritis with the signs and symptoms. But they may also recommend a few tests to confirm the diagnosis.
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Blood tests.
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Urine tests.
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Iothalamate clearance testing.
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Biopsy of the kidney.
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Imaging tests like ultrasound.
Blood Test:
Blood tests are used to look for the presence of waste products like creatinine and urea. Normally kidneys purify these waste products, whereas, in lupus nephritis, there will be elevated levels of these waste products. In these blood tests, the levels of creatinine in the blood are used to estimate the glomerular filtration rate (GFR).
Urine Test:
A urine test is used to determine the function of the kidney. It measures the levels of protein, red blood cells, and white blood cells.
24-hour Urine Collection:
This test is used to determine the kidney's ability to filter waste products. It also measures the amount of urine over 24 hours.
Iothalamate Clearance Testing:
This test is used to determine whether the kidneys are functioning properly. Contrast dyes are used to check if the kidneys are filtering the waste products. Radioactive iothalamate is injected into the blood to observe how quickly it is excreted in the urine from blood. This is one of the accurate tests to determine the speed of kidney filtration.
Biopsy:
A biopsy is considered one of the most effective ways to diagnose any kidney disease. The samples of the kidney tissue are collected to determine the signs of kidney damage. It is also used to determine how far the disease has progressed, and it also helps to guide the treatment.
Imaging Test:
Imaging tests such as ultrasound are used to create a detailed image of the kidney if any abnormalities in the shape and size of the kidney are determined.
What Are the Different Stages of Lupus Nephritis?
The severity of the kidney damage is classified as stages of lupus nephritis. The different stages of lupus nephritis are:
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Class I.
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Class II.
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Class III.
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Class IV.
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Class V.
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Class VI.
In the new classification, class I is removed, and Class VI is added.
How Is Lupus Nephritis Treated?
Lupus nephritis is treated with immunosuppressive drugs to suppress the immune system and stop it from attacking the body's own cells and damaging the kidney. The drugs prescribed to treat lupus nephritis are:
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Corticosteroids.
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Prednisone.
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Immunosuppressive drug.
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Cyclophosphamide or Mycophenolate Mofetil.
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Hydroxychloroquine- a drug prescribed for people with systemic lupus erythematosus (SLE).
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ACE (angiotensin-converting enzymes) inhibitors and ARBs (angiotensin receptor blockers)- Patients with lupus nephritis may have high blood pressure, so these drugs are also prescribed to control the high blood pressure.
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Diuretics - These drugs are prescribed to help the kidneys to remove the excess fluid from the body.
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Beta-blockers.
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Calcium channel blockers.
What Is the Goal of the Treatment?
There is no cure for lupus nephritis. The major goals of the treatment are:
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To relieve the symptoms of lupus nephritis.
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To reduce the inflammation of the kidneys.
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To stop the immune system from acting against the body's own cells.
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To stop the immune system from attacking the kidneys.
What Diet Should Be Followed for Patients with Lupus Nephritis?
A change in diet is required in patients with kidney disease. Healthy eating and meal planning are needed. If the patient has high blood pressure, then they may need to eat foods with low sodium. You can consult your doctor and get a diet plan according to your health. Eating the right foods can help you manage your kidney disease.
What Are the Complications of Lupus Nephritis?
Usually, the treatment works well for lupus nephritis. But there are few complications of lupus nephritis, and they are:
Lupus nephritis can result in permanent kidney damage, a condition called chronic kidney disease or CKD. The most severe form of lupus nephritis is proliferative lupus nephritis. This proliferative lupus nephritis can cause scars in the kidneys resulting in kidney damage. Chronic kidney disease is a worse condition, and it can prevent the kidneys from functioning, leading to kidney failure. About 1 in 10 people with lupus nephritis eventually end up in kidney failure.
People with lupus nephritis are more likely at a higher risk of developing cancer, B-cell lymphoma, a type of cancer that affects the cells of the immune system. They are also more likely to develop heart and blood vessel-related problems.
Conclusion:
Being diagnosed with lupus nephritis can be a shock for many people as it is a lifelong disease. Many people do not know much about it. Getting the right diagnosis is the initial step for getting the care you need. Though this disease can impact your daily routine in many ways, coping with this condition and getting the right treatment can help you have a better life.
