How can I manage lupus nephritis while working?

Question

Hello doctor,

I have lupus nephritis, and my last visit showed my creatinine was 1.6, and protein in my urine was still elevated. I am a nurse, so I cannot just call in tired. I have 12-hour shifts, and by the end of them, I can barely drive home.

How do I manage lupus nephritis fatigue while working at 55?
I do not want to give up my career, but I also feel like my body is running on empty every single day, and I do not know how much longer I can keep pushing through like this.

Kindly help me out.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com

I understand your concern.

Fatigue might be a sign of lupus activity. Occasionally, it might be the most disturbing feature of the disease. If your fatigue is not improving with medications, that means we might need to escalate your therapy.

I will suggest ordering a full laboratory workup to evaluate disease activity, including the following:

CBC (complete blood count).
Urine analysis.
Anti-dsDNA (anti-double-stranded deoxyribonucleic acid).
C3 (complement component 3).
C4 (complement component 4).

If there are signs of disease activity in the laboratory results, coupled with fatigue, I will suggest changing your treatment regimen. Increasing the steroid dose temporarily or even receiving a pulse intravenous steroid dose may help control fatigue. If you are on Mycophenolate mofetil, increasing the dose might be helpful, or shifting to a biological agent like Rituximab to control disease activity.

Make sure to use sunblock whenever you are in sunlight, as photosensitivity aggravates lupus fatigue.

Finally, fatigue might be due to secondary fibromyalgia rather than lupus activity if all your laboratory workup comes back normal. Managing such a condition might help alleviate your symptoms. A vitamin D deficiency might also aggravate the condition. We should check for all possible causes and not just lupus.

Investigations to be done:

CBC (complete blood count).
ESR (erythrocyte sedimentation rate).
CRP (C-reactive protein).
ALT (alanine aminotransferase).
AST (aspartate aminotransferase).
Serum creatinine.
Protein in urine (24-hour).
Anti-dsDNA (anti-double-stranded deoxyribonucleic acid).
C3 (complement component 3).
C4 (complement component 4).
25-hydroxy vitamin D

The treatment plan that you should follow is:

Steroid, 1 milligram per kilogram per day.
Mycophenolate mofetil 2 grams.
Hydroxychloroquine, 5 milligrams per kilogram per day.
Milnacipran should be dosed 12.5 milligrams per day for 5 days, then gradually increase the dose by 12.5 milligrams every 5 days until reaching 50 milligrams twice daily.
Amitriptyline 10 milligrams at bedtime.

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

Thank you.