1. Lupus Nephritis

2. What is Lupus? Lupus is a lifelong disorder of the immune system. Immune cells attack the body's own healthy tissues, leading to inflammation and tissue damage. Symptoms may be limited to the skin, but more often lupus also causes internal problems such as joint pain. In severe cases, it can damage the heart, kidneys, and other vital organs. Although there's no cure, there are treatments that can minimize the damage. Patients with lupus have production of autoantibodies and immune complexes formation. These antibodies can target against many nuclear antigens such as DNA, proteins, or against cytoplasmic or cellular membrane antigens. These immune complexes can be deposited or be formed in diverse tissues, activating the complement and releasing proinflammatory cytokines that produce tissue damage. Lupus patients will undergo chronic periods of unpredictable flare ups. Lupus Nephritis is an inflammation of the kidney caused by systemic Lupus erthematosus (SLE).

3. Continue.. Diagnosing lupus can be tricky. The disease can mimic other conditions, and it often takes a different course in different people. Many people have it for years before developing symptoms. Although there is no one test for lupus, certain proteins usually show up in a patient's blood. A blood test for antinuclear antibodies (ANAs) can provide a critical clue. Other lab tests may check cell counts, kidney function, and clotting time. A tissue biopsy of an involved organ such as the skin or kidneys sometimes helps with diagnosis. About 1.5 million Americans are and 5 million people worldwide are currently living with lupus (Lupus foundation, 2011). Lupus is most common in African American, Hispanic, Asian and Native American descent. Although the cause of lupus is not known, there have been suggestion that genes may play an important role. However, there are many factors that may trigger the disease.

4. Symptoms of Lupus Since lupus can affect different organs, a wide range of symptoms can occur: extreme fatigue (tiredness) headaches painful or swollen joints fever anemia (low numbers of red blood cells or hemoglobin, or low total blood volume) swelling (edema) in feet, legs, hands, and/or around eyes pain in chest on deep breathing (pleurisy) butterfly-shaped rash across cheeks and nose sun- or light-sensitivity (photosensitivity) hair loss abnormal blood clotting fingers turning white and/or blue when cold

6. Symptoms of Lupus Nephritis Patients with Lupus related to kidney disorders, do not experience any symptoms with the kidney until 70- 75% of renal function is gone. Most patients only learn about their kidney trouble when a urine test reveals blood or abnormal protein levels. The clinical signs of Lupus nephritis include increased loss of protein in the urine. This loss of protein leads to accumulation of sodium (salt) and water in the peripheral tissues leading to edema. Patients that lose over 3000 mg/24 hrs of protein (normal up to 150 mg/24 hrs) can develop Nephrotic syndrome; a condition where swelling is found throughout the body including the hands, feet, lower legs and eyelids. For many patient’s, the onset of proteinuria can be detected by patients if they notice that their urine has developed an unusual “foamy” character. The increase in urine foam is sometimes the result of increased urinary protein content. Another symptom found with Lupus nephritis is high blood pressure

7. Function of the Kidneys: The function of the kidneys is to deliver blood to the glomeruli, which are small filtering units of the kidneys, through small capillaries. The Glomeruli regulates blood pressure and electrolytes by removing or reabsorbing fluids and salt according to the body’s needs. Patients with lupus nephritis, have the large antigen complexes that circulate in the blood that can become lodged in the glomeruli and cause damaging inflammation. A healthy kidney only allows small molecules like salts to be removed from the body, and allows large protein molecules to remain in the blood. However, in kidney disease (lupus nephritis), causes proteins to leak out of the kidney into urine. High levels of protein in the urine, clinically called proteinuria, are indicative of kidney damage.

8. Treatment and Drugs The goal of treatment is to reduce symptoms and slow the progression of the disease. This disease increases the risk for blood clots in the lungs and legs. Patients are occasionally prescribed blood thinners to prevent these complications. Controlling blood pressure is the most important measure to delay kidney damage. The goal is to keep blood pressure at or below 130/80 mmHg. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are the medicines most often used. Corticosteroids and other drugs that suppress or quiet the immune system may be used, such as predinsone. The immune suppression medications that are used to treat lupus nephritis include (Imuran) and (Cytoxan), both of which can be given by mouth. Cyclophosphamide is also given as a single large dose (pulse) in certain situations. These pulses are continued monthly for six months and every three months thereafter.

9. Continued… FDA approved a new drug call Benlysta in March of 2011, which is the first new lupus treatment in 50 years. An FDA advisory panel voted 13-2 in favor of approval. But the panel noted that Benlysta is “no wonder drug.” Only 30% of patients who took the drug in clinical trials saw a benefit. And because the drug weakens the body's immune defenses, it comes with serious side effects. These include infections, cancers, depression, and suicide. Stem cells may help fight lupus. Patients have blood removed to harvest the stem cells. Next, chemotherapy destroys the existing, "broken" immune system. Patients are then given stem cells to build a new immune system

10. Living with Lupus A low salt diet may help with swelling in the hands and legs. Water pills or diuretics may also help with this problem. A moderate-protein diet (1 gram of protein per kilogram of body weight per day) may be suggested. Lupus patients must maintain a strict diet. Don't smoke. Exercise regularly. Improve stress management skills. Limit exposure to sunlight as this may cause a flare up. Get plenty of rest. Some people with lupus need up to 12 hours of sleep a night. However, when lupus nephritis leads to kidney failure, however, kidney dialysis or transplantation is necessary to sustain life.

11. Question What test can be done to see if the patient has kidney problems? Urine test, which will show if the patient has proteinuria.