Lupus Nephritis Causes Symptoms and Treatment

 

What is lupus nephritis caused by?

Lupus nephritis is an autoimmune inflammatory renal disease caused by Systemic Lupus Erythematous (SLE), an autoimmune systemic disease that affects the nephron apparatus and results in functional impairment of the kidneys. Lupus nephritis is characterized by proteinuria or cylinduria. Without prompt treatment, it may lead to renal failure and death.[1]

In Systemic Lupus Erythematous (SLE), the absolute number of natural killer cells (NK cells) is reduced, while the cytolytic activity is impaired, the condition is characterized by autoreactive T cells with an increased systemic and brain cytokine production.[1][5] Moreover, the lymphokine activated killer cell activity is also reduced.[2][3][4]

About 60 percent of patients with lupus will certainly develop lupus nephritis. Nephropathies often develop at the same time or shortly after SLE.[6][7]

What are the stages of lupus nephritis?

Lupus nephritis is classified in six classes or stages:

1. Stage I: Minimal mesangial lupus nephritis (normal glomeruli are seen by light microscopy; however, mesangial immune deposits are seen by immunofluorescence), requires no specific therapy
2. Stage II: Mesangial proliferative lupus nephritis, dietary sodium restriction and renin-angiotensin-aldosterone system (RAAS) blockade are often used to treat patients with LN (class II)
3. Stage III: Focal proliferative (or sclerosing) lupus nephritis, patients with LN (class III) are treated by glucocorticoids along with dietary sodium restriction and renin-angiotensin-aldosterone system (RAAS) blockade. Patients with moderate LN (class III) are treated by glucocorticoids ± MMF (mycophenolate mofetil). For patients with severe LN (class III): See treatment for class IV below
4. Stage IV: Diffuse proliferative (and sclerosing) lupus nephritis (segmental or global), patients with LN (class III, IV, or V) are treated by protocol-based administration of intravenous (i.v.) cyclophosphamide (CYC) or mycophenolate mofetil (MMF)
5. Stage V: Membranous glomerulonephritis, patients with LN class V are treated by low-dose glucocorticoid therapy (≤7.5 mg/day prednisone or equivalent) along with short-term administration of intravenous (IV) cyclophosphamide (CYC) as a remission induction treatment followed by azathioprine (AZA), ciclosporin or mycophenolate mofetil (MMF) as a maintenance treatment
6. Stage VI: Advanced sclerosis lupus nephritis in which 90% of glomeruli are sclerosed without residual activity

Symptoms

What are the symptoms of lupus nephritis?

Lupus nephritis is an autoimmune determined disorder characterized by late-onset nephropathy with a very mild clinical start, the initial symptoms may not be dramatic enough to call special attention to seek medical care. Commonly, an edema in the legs or feet along with the typical butterfly rash might be of the very first symptoms. Less frequently, an edema in the hands or face might be noticed.[1][7]

Other symptoms may vary from person to person, and from day to day. Some common symptoms include:

1. Weight gain (obesity).
2. High blood pressure (hypertension).
3. Dark foul-smelling urine.
4. Foamy urine and high urine osmolality, urine looks thick.
5. Nocturia or the necessity to urinate during the night.

People with lupus are prone to urinary tract infections, which can cause a burning sensation with urination. such infections require antibacterial treatment.[1]

Patients with lupus nephritis must be aware of the potential therapeutic side effects, as some medications can impact the function of the kidneys and increase inflammation causing a variety of symptoms similar to those caused by lupus nephritis. Problems associated with these drugs usually disappear when the drugs are no longer utilized.[1]

Diagnosis

How to diagnose lupus nephritis?

The diagnosis of lupus nephritis starts with a general healthcare assessment, disease background case study, physical exams, and a careful assessment of symptoms. Your physician will likely order some tests to confirm the diagnosis.[8]

Common tests used in diagnosing lupus nephritis include:

1. Urinalysis to screen for the presence of proteinuria, microalbuminuria, hematuria, red blood cells casts, or white blood cells in the urine
2. Blood tests to look for elevated levels of waste products, such as creatinine and urea
3. Imaging tests ex. ultrasound to look for anything abnormal in the size and shape of your kidney
4. Kidney biopsy is an invasive way to diagnose kidney disease in which a sample of kidney tissue is removed by a long needle and analyzed for signs of damage
5. Iothalamate clearance test procedure, an Iothalamate study is a diagnostic procedure used to find out your glomerular filtration rate (GFR) for each kidney and to see if your kidneys are filtering properly. During this test radioactive iothalamate is injected into your blood. Your doctor will then test Renal 125iodine (I)-iothalamate clearance to see how quickly it’s excreted in your urine and to test how quickly it leaves your blood, after a single subcutaneous injection

Treatment of Lupus nephritis

How to treat lupus nephritis?

There are six types of lupus nephritis. The treatment is based on the type of lupus nephritis, the degree of fibrosis, and the severity of inflammation, which can be determined by biopsy; However, the treatment is tailored individually to meet the person’s specific conditions, since the intensity and clinical picture vary from one patient to another.[1][9][10]

Medications used in treatment may include:

Corticosteroids are anti-inflammatory drugs prescribed to reduce inflammation and suppress the immune system; However, long term usage of corticosteroids can cause side effects and contribute to diseases like diabetes, anemia, atherosclerosis, and cardiovascular disease.

There are different types of steroids used in the course of treatment; However, prednisone pills, and cortisone injections are often used for the acute, and long-term treatment of lupus nephritis.

Corticosteriods play an important role in saving the person’s life, and the use of such drugs remains vital, as no alternative drug have sufficient evidence to support.

Doctors must prescribe Corticosteriods cautiously until the signs and symptoms of lupus nephritis decline, so patient monitoring is still mandatory all through the treatment course. Corticosteriod doses should usually be reduced as soon as the symptoms begin to decline.[1][11]

Immunosuppressive drugs a class of drugs that suppress the immune system, and reduce the immune reactions against various types of cells or antigens, which can be native cells as in the case of lupus. these drugs are related in order to the class of drugs used to control cancer or those used to prevent the rejection of transplanted organs. Common immunosuppressive drugs used in the course of treatment include cyclophosphamide (Cytoxan), azathioprine (Imuran), or mycophenolate (Cellcept).[12][13]

Medications to avoid blood clots (thrombolytics), or hypertensive drugs (that reduce blood pressure) are always ready to use immediately.

Prognosis

Regardless of treatment outcome, severe nephropathy develops and patients with lupus nephritis may eventually require dialysis, which is a process for removing waste toxins and water load from blood.[14]

Eventually, it may be required to undergo kidney transplantation; Moreover, patients who have had a kidney transplant need lifelong immunosuppressive drugs to keep them from rejecting the kidney transplant.[15]

Lifestyle modifications and Lupus nephritis diets

How to treat lupus nephritis naturally?

Lifestyle Changes are required to deal with lupus Nephritis

Certain lifestyles can help protect against kidney damage. People with lupus nephritis are encouraged do the following:

1. Drink enough liquids to stay well hydrated.
2. Start a low-sodium diet, highly recommended especially if the patient has severe hypertension.
3. Lower intake of potassium, phosphorus, and proteins, especially if you suffer from suprarrenal malfunction.
4. Avoid smoking and abide from drinking alcohols.
5. Exercise regularly.
6. Sustain a healthy blood pressure.
7. Limit the consumption of fast food, and try not to eat foods that contain too much cholesterol, exclude animal fat from meals and use olive oil or fish oil as the only source of fat.
8. You may need to avoid some drugs that can impact kidney function, such as non-steroidal anti-inflammatory drugs (NSAIDs).
9. Consult with your doctor, and ask him to tell you more about your condition, and what kind of food is suitable for you, let him help you start a proper diet.

Although lupus nephritis is a serious issue, proper treatment should help prevent further damage to your kidneys, which can lower your risk of developing renal failure.

 

 

 

References

 

Verified by: Dr.Diab (September 16, 2018)

Citation: Dr.Diab. (September 16, 2018). What is Lupus Nephritis? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 31(2). urn:medcoi:article1186.