Could my lupus be affecting my kidneys?

Question

Hello doctor,

I am a 28-year-old woman who was diagnosed with systemic lupus erythematosus (SLE) approximately two years ago. However, I have recently been experiencing new symptoms that are causing concern.

I have noticed significant swelling in my feet, ankles, and around my eyes, particularly in the mornings. My urine has been foamy and occasionally has a reddish tint. I have also been feeling more fatigued than usual, despite taking my prescribed lupus medications.

My blood pressure has been consistently higher than normal, and I have gained approximately 10 pounds over the past month, even though I have not made any changes to my diet or lifestyle.

In addition to my usual lupus symptoms, such as joint pain and skin rashes, I am now experiencing headaches and episodes of nausea. Recent laboratory tests have revealed the presence of protein in my urine (proteinuria) and elevated serum creatinine levels, which I understand may be indicative of kidney dysfunction.

Could my lupus be affecting my kidneys, possibly indicating lupus nephritis? If so, what might this mean for my long-term health, and what further tests or treatments should I consider?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Yes, your symptoms, such as swelling in the legs and around the eyes, foamy and discolored urine, elevated blood pressure, unexplained weight gain, fatigue, and laboratory findings of proteinuria and elevated serum creatinine, strongly suggest possible lupus nephritis, which is a serious kidney complication of systemic lupus erythematosus (SLE).

Lupus nephritis occurs when the immune system attacks the kidneys, causing inflammation and impairing kidney function. If not treated early and aggressively, this condition can progressively worsen, potentially leading to chronic kidney disease (CKD) or even kidney failure.

Headaches and nausea may also result from elevated blood pressure or the accumulation of waste products in the body if the kidneys are not functioning adequately.

To confirm the diagnosis, the following investigations need to be done:

Urine tests to evaluate protein levels, red blood cells, and other abnormalities
Blood tests to monitor kidney function, including serum creatinine and glomerular filtration rate (GFR)
Kidney biopsy to determine the class and severity of kidney involvement.

Treatment approach:

Management may involve adjusting or intensifying your immunosuppressive therapy. This could include:

Corticosteroids (Prednisolone, corticosteroid class).
Mycophenolate Mofetil (Immunosuppressant, antimetabolite class).
Cyclophosphamide (Immunosuppressant, alkylating agent class).

In addition, you may be advised with the following supportive treatments:

Medications to control blood pressure, often angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)
Regular monitoring of kidney function through follow-up lab tests.
Dietary modifications, such as reducing protein and sodium intake, as per the guidance of a nephrologist or dietitian

Early diagnosis and timely treatment are critical for preserving kidney function and improving your long-term prognosis. Please consult your rheumatologist and nephrologist promptly to initiate appropriate investigations and management.

I hope this helps.

Thank you.