I have lupus. Can lifestyle changes slow kidney damage?

Question

Hello doctor,

I am a 44-year-old female, diagnosed with lupus eight years ago, now with kidney involvement confirmed by biopsy (class III). My creatinine is 1.1, and my urine protein is 1.3 g/day. I have started Mycophenolate and Prednisone, but I am worried about side effects like infections. I have a few concerns, like -

How closely should blood counts and kidney tests be monitored during treatment?
Is it possible to achieve complete remission, or is kidney damage usually permanent once it starts?
Also, are there lifestyle factors that can really make a difference in slowing further kidney damage, along with medication? I am hoping to avoid dialysis in the long run if possible.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

In lupus nephritis, especially class III as in your case, careful monitoring is essential while on immunosuppressive therapy like Mycophenolate and Prednisone. Blood counts, including white blood cells, hemoglobin, and platelets, should typically be checked every two to four weeks during the initial months of therapy, then spaced out once stable, to detect bone marrow suppression and infection risk promptly.

Kidney function tests, including serum creatinine, estimated GFR (glomerular filtration rate), and urinalysis for proteinuria, are usually monitored every four to eight weeks initially, and more frequently if any changes are noted.

Achieving complete remission is possible, particularly when therapy is started early and adherence is good; complete remission typically involves normalization of proteinuria and stabilization of kidney function. However, some degree of chronic damage may persist depending on the extent of inflammation and scarring at diagnosis.

Lifestyle factors can significantly support kidney health and slow progression.

Maintaining optimal blood pressure, ideally below 120/80 mmHg (millimeters of mercury), is important and often requires ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin II receptor blockers).
A balanced diet low in salt, avoiding excessive protein restriction unless recommended.
Staying well-hydrated.
Maintaining a healthy weight.
Avoiding smoking contributes to kidney protection.
Minimizing infections by practicing good hygiene and receiving recommended vaccinations, while staying vigilant for early signs of infection, is crucial during immunosuppression.

Regular follow-up with your nephrologist and rheumatologist, along with prompt reporting of any new symptoms like swelling, changes in urine output, fever, or fatigue, can help maximize your chances of long-term kidney preservation and reduce the likelihood of needing dialysis.

I hope this helps.

Thank you and take care.

Regards.