Lupus Nephritis

Overview

Lupus Nephritis is a health condition affecting the kidney that results from the effect of lupus erythematosus, also called lupus. Lupus erythematosus is a disease caused by autoimmune reactions in the body. Autoimmune reactions are abnormal blood reactions in which your normal body cells, tissues, or organs are being attacked by the white blood cells by producing proteins called autoantibodies.

Immune reactions are meant to protect the body against infections and diseases. Still, when it is self-destructive, it is called autoimmune disease as the white blood cells recognize your body cells, tissues, or organs as foreign and hence attack them. Attacking at the cellular or tissue level affects organs such as the kidney, affecting its internal structures and causing kidney inflammation. This inflammation leads to kidney malfunctioning and results in uremia, blood in urine, increased blood pressure, or, worst, kidney failure. The harmful effect of the autoimmune disease on the kidney is termed Lupus Nephritis. 

Key Facts

The important things to know about Lupus Nephritis are: 

• It affects the disease condition lupus erythematosus, simply called lupus or systemic lupus.
• The exact cause of systemic lupus is unclear, but some factors triggering immune responses include genes, hormones, and environment.
• Early detection of lupus nephritis is essential because it will help prevent the progressive stage of the disease through the use of immunosuppressive medications.
• The resultant effect of lupus nephritis is kidney failure which happens when more than 90% of the kidney has been damaged.
• Aside from other symptoms of lupus nephritis, such as fatigue, foamy urine, varying blood pressure, weight gain, and swelling of the feet or ankles, the primary symptom of lupus nephritis is hematuria which means the presence of blood in the urine. 
• Lupus nephritis can be managed by using medications channeled toward the patient’s immune system to suppress its strength. These medications include immunosuppressants, corticosteroids, and chemotherapy. Additionally, antimalarial and blood pressure drugs can be adopted as preventive measures against kidney damage.

Types of Lupus Nephritis

Lupus Nephritis is instead classified according to the stages of disease progression. It is divided into six (6) different classes depending on the results of the patient’s kidney biopsy. They include:

• Class 1 Minimal Mesangial Glomerulonephritis: This is minimal kidney damage. There are no obvious symptoms associated with this class.
• Class 2 Mesangial Proliferative Glomerulonephritis: This is the proliferation stage, as there is some damage to the kidney, like minor damage to the kidney’s blood vessels. The patient experiences some symptoms, such as tiny amounts of blood in the urine or the presence of proteins in urine.
• Class 3 Focal Glomerulonephritis: This is the intermediate stage. There is about 50% or less damage to the kidney’s blood vessels. Patients also have high amounts of proteins in the blood, higher amounts of blood in urine compared to Class 2, and also, patients may experience high blood pressure.
• Class 4 Diffuse Proliferative Nephritis: At this stage, more than 50% of the kidney’s blood vessels have been damaged. A worse kidney malfunctioning state characterizes as the kidney will not be able to filter waste products from the blood. High waste products get deposited in the blood leading to increased blood pressure and edema of the leg. At this stage, patients will need dialysis for blood purification and survival.
• Class 5 Membranous Glomerulonephritis: This stage is characterized by the thickening of structures in the kidney, Increased blood pressure, and excessive deposits of proteins in urine. Patients could be managed or sustained through dialysis. But at this stage, the best recommendation is a kidney transplant.
• Class 6 Advanced Sclerosis: The damage to the kidney at this stage is more than 90%, and there is a slight possibility that the patient can survive without treatment such as dialysis or kidney transplant. 

Symptoms 

The symptoms of lupus nephritis have close similarities with other kidney diseases as the body reacts the same way once the kidney is damaged. These include:

• Hematuria: This means the presence of blood in the urine. Kidney physiology is to prevent blood cells from entering the urine by filtration action. But when the kidney is weak due to damage, it loses the capacity to filter blood cells, and they escape into the urine, making it pink or light brown.
• Foamy Urine: The urine becomes frothy or bubbly due to the presence of proteins. The pathology of this is sourced from kidney damage and its inability to filter proteins.
• Edema: This simply means swelling. Lupus nephritis is a symptom of swelling of the feet, hands, or ankles.
• Presence of waste products in blood: Waste such as creatinine is found in blood since the kidney can not filter waste and purify the blood.
• High blood pressure: Blood pressure can be increased due to increased impurities or wastes in the blood

Diagnosis 

Diagnosis of lupus nephritis starts with the doctor asking the patient a series of questions relating to medical history. This progresses to physical examination as the doctor checks for swelling at the feet, hands, or ankles, and blood pressure using bp apparatus. The doctor then will require the patient to run some tests, which include blood tests, urine tests, ultrasounds, and kidney biopsies. The results from these tests will give the doctor confirmation of the presence of the disease condition as well as the degree or level of the disease if present already.

Causes

The cause of Lupus nephritis is Systemic Lupus or Systemic Lupus Erythematosus (SLE).  Tracing for the root cause of lupus nephritis is the same as tracing for the cause of SLE. The actual cause of SLE is still unclear as so many factors can trigger an immune response against your body. These factors include:

• Environment:  Many environmental factors have been proven to trigger autoimmune responses; these include Smoke from Cigarettes, Mercury, UV rays, Silica, and Viruses such as cytomegalovirus, Herpes zoster, and Epstein-Barr
• Gene: Some group of genes raises the chances of having SLE, genes of people from ethnicity such as Native America, Africa, Hispanics, Asia, and the Pacific Islands. Although the evidence of this is still unclear, there is still no explicit knowledge of how this particular ethnic gene causes the autoimmune disease SLE.
• Hormones: Statistics have shown that women have a higher risk of the disease since lupus symptoms tend to increase as women approach their monthly periods or during their pregnancy when estrogen level is high.

Prevention

Possible preventive measures that reduce the risk of lupus nephritis also apply to systemic lupus erythematosus. These include:

• Avoid exposure to Smoke from Cigarettes 
• Do not expose yourself to UV light or Xrays. If the doctor requires tests involving such rays, inform the doctor of the last time you were exposed to such.
• Treat any infection caused by Virus by using antiviral medications

Typical Treatment

Lupus nephritis can be managed or treated using medications that suppress the patient’s immune system. This is because the patient’s immune system is active and reacting against itself hence being destructive. Stopping such immune systems will reduce the harmful effects of such autoimmune reactions. Although this will leave the patient prone to being infected easily by diseases, the goals of using the suppressing medications are achieved. The plan includes reducing inflammation of the kidney and blocking the patient’s immune cells from producing antibodies that attack the kidney.

The medications the doctor can use to achieve this include:

• Corticosteroids: These is simply called steroids. A drug that belongs to this group is prednisone.
• Immunosuppressant: This is used to suppress the immune system.  Examples are cyclophosphamide, hydroxychloroquine, and mycophenolate mofetil.
• Blood pressure drugs: Since lupus patients have high blood pressure, the doctor can use drugs such as ACE inhibitors that have -sartan or -pril ending their names
• Diuretics: These drugs assist your kidney in eliminating fluid from the body.

Conclusion

A lupus nephritis patient should not hesitate to see the doctor if early symptoms are seen as a delay progresses the rate of damage to the kidney. The kidney is one of the most essential organs of the body, and when damaged, the patient will live on dialysis or a kidney transplant. Although some medications to treat or manage this disease condition exists, the patient is left prone without a natural means of combating diseases; hence patients under treatment are advised to use facial masks outside. And if inside their house, they should ensure a clean environment.

MOST COMMON