I have lupus nephritis. How do I monitor medication side effects?

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

I understand and hear your concerns.

Class IV lupus nephritis is a severe form of kidney involvement in systemic lupus erythematosus (SLE), causing significant inflammation in the glomeruli.

Do not worry, as early and appropriate treatment with immunosuppressants like Mycophenolate and corticosteroids aims to control inflammation, reduce proteinuria, and preserve kidney function over the long term.

With careful monitoring and adherence to therapy, many patients maintain good kidney function. I will explain and educate you on what you need to manage this condition and live your life with ease.

Some investigations that help you monitor your disease are:

1. RFTs (renal function tests) such as creatinine and urea.

2. eGFR (estimated glomerular filtration rate) is calculated by the doctor to estimate kidney function.

3. LFTs (liver function tests).

4. Urine routine examination to check for hematuria, casts, and pus cells (pyuria).

5. CBC (complete blood count) for pancytopenia.

6. Lipid profile.

7. BP (blood pressure) monitoring to protect the kidneys.

8. Special tests, such as antibodies and complement levels to assess disease activity.

Other conditions that manifest with similar symptoms are:

1. Lupus nephritis.

2. Drug-induced nephropathy due to NSAIDs (non-steroidal anti-inflammatory drugs) or other medications.

3. Hypertensive or diabetic nephropathy.

4. Other glomerular diseases, such as IgA (immunoglobulin A) nephropathy or minimal change disease.

Treatment for lupus nephritis includes the following:

Immunosuppressive therapy:

• Tablet Mycophenolate mofetil, considered primary therapy for Class IV lupus nephritis.

• Tablet corticosteroids such as Prednisone 5 mg for the induction of remission.

• Capsule PPIs (proton pump inhibitors) such as Omeprazole 400 mg during relapse to avoid gastritis due to steroids.

Adjunct therapy:

• If blood pressure is high, use ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) to reduce proteinuria and other complications.

• If lipid levels are high, manage with a statin tablet once at night.

Medication side-effect monitoring:

1. As already mentioned, pre-tests are required for monitoring organ functions.

2. Steroid side effects include weight gain, blood sugar elevation, osteoporosis, and increased risk of infections.

That is why regular follow-up is necessary for patients with this autoimmune condition. Regular follow-up and monitoring of the following is the mainstay of treatment.

1. Regular tests: creatinine, eGFR, urine protein, CBC, LFTs, RFTs

2. Blood pressure control.

3. Take medications as prescribed (Mycophenolate, steroids).

4. Infection prevention and timely vaccinations.

5. Maintain bone health (calcium, vitamin D).

6. Balanced diet, adequate hydration, and avoidance of smoking.

7. Report new symptoms promptly, such as swelling, fever, or reduced urine output.

I hope this helps.

Thank you.