What is Lupus Nephritis?

Lupus nephritis is inflammation of the kidney as a result of lupus or SLE (systemic lupus erythematosus). SLE is a condition whereby your organs and cells are attacked by your own immune system, making it an autoimmune disease. Approximately 60% of SLE patients are found to have lupus nephritis and this can cause a major ailments and at times death, in severe cases.

According to research, 35 percent of US adults display nephritis signs during a diagnosis of lupus and up to 40-60 percent of individuals will get kidney complications as the condition progresses. The above figure rises to 75 percent in African Americans. Nephritis can cause major disorders and sometimes even death, if it is not found and treated early.

Lupus nephritis signs and symptoms

Individuals suffering from lupus nephritis may experience the following:

• Other symptoms of SLE  are fever, rash, CNS disease (central nervous system), fatigue, arthritis, serositis, or rash. These symptoms are frequent in diffuse proliferative and focal proliferative lupus nephritis.
• Asymptomatic lupus nephritis -  Laboratory irregularities may point to active lupus nephritis. This is frequent in membranous or mesangial lupus nephritis
• Active nephritis -  Peripheral edema resulting from hypoalbuminemia or hypertension. Severe cases of peripheral edema are most frequent in membranous or diffuse lupus nephritis.
• Diffuse lupus nephritis - Dizziness, headache, problems with vision or cardiac decompensation signs
• Diffuse and focal lupus nephritis: Rash, serositis, nasal or oral ulcers or synovitis
• Active lupus nephritis: Peripheral edema, hypertension  and infrequent cardiac decompensation
• Membranous lupus nephritis: Ascites, peripheral edema, and pericardial and pleural effusions with no hypertension.

How to diagnose lupus nephritis

The diagnosis of lupus nephritis is conducted via a kidney biopsy and blood and urine tests

• Urinalysis: This is urine testing. Using a particular container, the sample for the urine is collected in a doctor’s office and can then be sent for analysis to a lab for testing. A chemically treated paper known as dipstick is placed in the urine. When there is protein or blood, there will be a change in color on the dipstick patches. You will be diagnosed with kidney damage if there are high protein levels or large quantities of red blood cells in the urine.
• Blood test: A blood sample will be taken from you and then tested in a lab. High creatinine levels may be indicated in the test. This is a waste product expelled by the kidneys which increases when there is improper kidney function.
• Biopsy: This is when a sample of the kidney tissue is taken to be examined through a microscope. This test is done by a doctor with local anesthetic and light sedation. A CT scan or an ultrasound is used to direct the biopsy needle to the kidney.  A pathologist examines the kidney sample. Through this test, there can an affirmation that you have lupus nephritis, the status of the condition and which treatment to opt for.

The following are laboratory tests for the SLE disorder:

• dsDNA (double-stranded DNA) antibodies
• CRP ( c-reactive protein)
• ESR (erythrocyte sedimentation rate
• Complement: CH50, C4 and C3

 What are the lupus nephritis stages?

There are different classifications of lupus nephritis:

• 1^st class- mesangial nephritis which is minimal
• 2^nd class-mesangial proliferative nephritis
• 3^rd class- Focal lupus nephritis
• 4^th class- Diffuse nephritis
• 5^th class- membranous nephritis
• 6^th class- sclerosis nephritis which is advanced

 How to manage lupus nephritis

The main aim of lupus nephritis treatment is to return the renal function to normality or stop the renal function from worsening. Lupus nephritis is managed as follows:

• Individuals with clinical proof of lupus which is not treated or active should undergo a renal biopsy to classify the condition
• Everybody suffering from lupus nephritis should get background treatment using hydroxychloroquine.
• Individuals with 1^st and 4^th class should be given glucocorticoids together with oral mycophenolatemofetil or intravenously with cyclophosphamide.
• The blood pressure should be kept at 130/80 mm Hg or below that
• Angiotensin- If proteinuria goes beyond 0.5g per day, receptor blockers should be given to the patient.

Individual with 5^th class nephritis are treated for one to three months with prednisone and if a response develops, tapering is offered for one to two years.

 Therapies for lupus nephritis

They include:

• Belimumab
• Rituximab
• Anticytokine therapies
• Abetimus
• Atacicept
• Other antibodies of anti-CD20 monoclonal

Dialysis and kidney transplant may be needed for individuals in the final stage of renal disorder.

Medicines that suppress the immune system are used to treat lupus nephritis to avoid kidney damage. To minimize kidney inflammation, corticosteroids are used. Prednisone is used together with immunosuppressive medicines like mycophenolatemofetil or cyclophosphamide. These medicines if taken properly, minimize immune system activity and obstruct the immune cells from directly attacking the kidneys or generating antibodies that show aggression to the kidneys. Antibodies are proteins that are generated by the immune system to guard your body from unfamiliar substances like viruses and bacteria. Lupus nephritis patients should take hydroxychloroquine.

Individuals with high blood pressure as a result of lupus nephritis require medications that bring their blood pressure down and can make the progression of kidney disorder decelerate. ARBs (Angiotensin receptor blockers) and ACE (Angiotensin-converting enzyme) inhibitors are medications that bring blood pressure down. They also effectively slow the development of kidney disorder. The majority of individuals need two or more medicines to regulate their blood pressure. A diuretic (medicine that enables the kidneys to eliminate fluid from your body) may be recommended in addition to ARBs or ACE inhibitors. Other medications include calcium channel blockers, beta blockers and other medicines for blood pressure.

Blood pressure is noted down as two numbers with a slash separating them, 120/80 and is pronounced as 120 over 80. Systolic pressure is the top number and stands for the heart beat's pressure and propels blood via the blood vessels.  Diastolic pressure is the bottom number that stands for the pressure at which blood vessels relax in between heartbeats. A diastolic pressure of more than 90 and a systolic pressure of more than 140 signify high blood pressure.

Lupus nephritis potential complications

Treatment of lupus nephritis is mostly effective and as a result there are minimal complications, if any.  Even when treatment is given, approximately 30% of lupus nephritis patients get kidney failure known as ‘end-stage renal disorder’, when treatments for blood filtering are given such as kidney transplants or dialysis. It is impossible to foretell how different patients will respond to treatment. Diffuse proliferative nephritis is the most severe type of lupus nephritis. In this form of ailment, there is inflammation of the kidneys, invasion of the kidneys by numerous white blood cells, and an increase in amount of kidney cells, which can result in extreme damage or scars in the kidneys. It is hard to cure scars and as more scars develop, kidney function reduces. To avoid such chronic, long-term damage, lupus nephritis should be diagnosed early and treated as soon as possible.

Lupus nephritis patients are more prone to cancer, blood vessel and heart complications.

Lasting outlook for lupus nephritis patients

The outlook for lupus nephritis patients differ. The majority of individuals only experience intermittent symptoms. During urine tests is when kidney damage will be observed.

People with severe symptoms of nephritis are more likely to lose functionality of their kidneys. Although they are not always effective, treatments can slow the development of nephritis. Consult with your doctor about the appropriate treatment for you.