Does controlling lupus prevent long-term kidney damage?

Question

Hello doctor,

I was diagnosed with lupus nephritis about two years ago, and I am currently on Hydroxychloroquine and a low dose of Prednisone. My last 24-hour urine showed protein at 380, and creatinine was 1.2. I am 43, and honestly, my biggest fear is ending up on dialysis someday.

Does controlling lupus flares protect the kidneys long-term at 43, or does kidney damage keep progressing even when you are doing everything right and taking all your medications?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

If you are already diagnosed with nephritis and your proteinuria level is 380, then everything is going well, and we plan to keep everything in check, prevent flares, or detect them as early as possible. Your target is proteinuria of less than 500.

I suggest adding Mycophenolate mofetil 2 grams to your treatment regimen, as Hydroxychloroquine is not enough in nephritis cases, and we want to prevent flares. Mycophenolate mofetil is a great option for nephritis and is mostly safe in the long term.

You will need to follow up regularly with new laboratory work every 3 to 4 months. The investigations include:

Complete blood count.
Erythrocyte sedimentation rate.
C-reactive protein.
Alanine aminotransferase.
Aspartate aminotransferase.
Serum creatinine.
Urine analysis.
24-hour urine protein.
Anti-double-stranded deoxyribonucleic acid.
Complement component 3.
Complement component 4.

These investigations are important to detect any rising flare, as nephritis tends to be silent and can occur without major symptoms.

As long as you are regular with your treatment and follow up regularly, everything will be fine. Just never neglect lupus, even when things are going well. Your treatment plan includes:

Prednisolone 10 milligrams.
Hydroxychloroquine 5 mg/kg/day (milligrams per kilogram per day).
Mycophenolate mofetil 2 grams.
Captopril 25 mg/day (milligrams per day).
Calcium and vitamin D supplements.

You should follow up every three months with repeat investigations. In addition:

Avoid nephrotoxic agents.
Avoid analgesics.
Maintain good hydration.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.