Lupus nephritis is an inflammation of the kidneys caused by systemic lupus erythematosus (SLE). SLE, in turn, is an autoimmune disease that, in addition to affecting the skin, can also affect various organs or regions of the body. Thus, in patients suffering from lupus nephritis, the kidneys are affected.
What is lupus nephritis?
About 70 to 100 percent of patients who have SLE also have lupus nephritis. According to histology, all SLE patients may also carry lupus nephritis, even if clinical examinations do not yet show damage to the kidneys. The name is derived from the Latin word “lupus” (the wolf) and “nephritis” (a collective term for all inflammatory diseases of the kidneys). The disease occurs in relapses. After an episode has subsided, the skin of lupus patients is said to resemble a wolf’s face due to the scar-like depressions, which explains the name of the disease. Lupus nephritis involves glomerulonephritis, which is an abacterial (without evidence of germs at the site of inflammation) inflammation that usually affects both kidneys. The glomeruli are small collections of vessels or nerves. In the kidneys, they are an essential part of the renal corpuscles, which are responsible for the filtration of urine. If left untreated, lupus nephritis can lead to total kidney failure.
Causes
As described earlier, lupus nephritis occurs in most patients who have systemic lupus erythematosus. This is an autoimmune disease that belongs to the group known as collagenoses. This means that the body’s own immune system attacks its own connective tissue and triggers inflammation there. As a rule, such diseases occur in middle age. Women are affected more frequently than men. The exact cause of lupus erythematosus is unknown, but certain predominant genetic factors that favor the disease stand out. External circumstances, such as hormonal changes, stress, other infections or even medication, can also trigger lupus nephritis. Patients suffering from SLE should therefore also be tested for kidney function in any case in order to diagnose or rule out the possible presence of lupus nephritis. If the disease remains untreated, total kidney failure can be the result. Therefore, the earlier lupus nephritis is detected, the more favorable the prognosis for those affected.
Symptoms, complaints and signs
Lupus nephritis is a serious disease. Unfortunately, it is not always easy to diagnose right away, as it can have a number of nonspecific symptoms. However, doctors should look more closely if patients complain of swelling of the legs, especially the ankles. Sometimes, the hands or face may also swell. Other symptoms of lupus nephritis may include an increase in weight or high blood pressure. It is also suspicious if the urine is dark in color or foamy. Nighttime urination may also indicate lupus nephritis. Proteinuria, which is an increased accumulation of protein in the urine, and microhematuria (blood in the urine that is not visible to the naked eye) should also alert the doctor. In rare cases, lupus nephritis also shows macrohematuria, which means there is so much blood in the urine that it is visible without a microscope. Some medications given for lupus can also cause these symptoms; in this case, temporarily stopping the medication may bring clarity.
Diagnosis and disease progression
Once a patient has been diagnosed with SLE, the physician will order a series of examinations and tests to check kidney function. These initially include a detailed medical history and physical examination. An ultrasound examination of the kidneys and various laboratory tests that are common for kidney problems (blood and urine tests) also provide information. Finally, the diagnosis is completed by kidney biopsy. There are six types of lupus nephritis, classified according to ISN/RPS (International Society of Nephrology/Renal Pathology Society)as follows:
- I. Minimal mesangial lupus nephritis.
- II. mesangial proliferative lupus nephritis
- III Focal lupus nephritis
- IV. Diffuse segmental or global lupus nephritis.
- V. Membranous lupus nephritis
- VI.Advanced sclerosed lupus nephritis
The result of the biopsy provides information about which type of lupus nephritis it is. The severity and course of the disease vary from patient to patient, so no blanket statement can be made here.
Complications
In many cases, lupus nephritis cannot be diagnosed directly, so early treatment is not possible in many cases and therefore does not take place. As a rule, however, those affected suffer from severe swelling of the legs and thus, in many cases, restricted movement or even pain. Furthermore, the swellings can also occur on the hands or even on the face, reducing the aesthetics of the affected person. It is not uncommon for this to result in reduced self-esteem or inferiority complexes. Furthermore, lupus nephritis leads to a nocturnal urge to urinate, which can lead to depression and other psychological upsets. In the worst case, this disease leads to renal insufficiency, which can further lead to the death of the affected person. The treatment of this disease is carried out with the help of medications. There are no particular complications and the course of the disease is usually positive. However, the drugs can have severe side effects. In severe cases, the affected person is dependent on a kidney transplant or dialysis. This can sometimes result in a reduction in the patient’s life expectancy.
When should you see a doctor?
Consultation with a physician is indicated as soon as discomfort and irregularity in urination occur. Discoloration of the urine, changes in the consistency of the urine, or renewed urinary pressure immediately after going to the toilet should be examined and treated by a physician. If the amount of urine decreases or fluid intake is refused, it is advisable to consult a physician. If the affected person repeatedly awakens during night sleep due to a need to empty the bladder, this is considered unusual and should be monitored further. If the complaints persist over a longer period of time, although no heavy fluid intake takes place immediately before bed rest, the indications should be discussed with a physician. If there is an unexplained increase in body weight, a diffuse feeling of pain inside the body or a general feeling of malaise, a visit to the doctor is necessary to clarify the cause. If there is a feeling of illness or psychological abnormalities, consultation with a physician is necessary. If withdrawal behavior is noticed, participation in leisure activities decreases or mood swings set in, there is a need for action. Swelling and thickening of the legs and ankles are signs of health problems. A visit to the doctor should be made so that treatment can be initiated. If the affected person suffers from complaints of mobility, a decrease in physical performance or internal weakness, a comprehensive examination is recommended to clarify the symptoms.
Treatment and therapy
Because lupus nephritis is so multifaceted, treatment is tailored to the individual patient. Initially, the physician will attempt to control the disease with medications. Administration of corticosteroids may relieve an acute inflammatory flare. Since these drugs can have severe side effects, the patient must be closely monitored. Usually, the dose is reduced as soon as symptoms improve. Immunosuppressive drugs can also be used. They suppress the immune system‘s activity that damages the kidneys. Cyclophosphamide, azathioprine or mycophenolate belong to the family of immunosuppressants. Furthermore, in some cases, blood thinners or antihypertensives are also given. However, drug therapy cannot always prevent further deterioration of kidney function. If total kidney failure occurs, the patient will require dialysis and, in extreme cases, even a kidney transplant.
Outlook and prognosis
The prognosis of lupus nephritis depends on the stage of the disease. In addition, the general health of the affected person is crucial for the further course of the disease. A cure is possible if the diagnosis is made at an early stage and the affected person is not suffering from any other diseases. If left untreated, irreparable kidney damage can result.In severe cases, the affected person is threatened with premature death. A similarly unfavorable course of the disease is seen in patients in whom the disease is at an advanced stage. The particular challenge is to diagnose the disease at an early stage, since the symptoms are usually diffuse and a doctor is only consulted at a late stage. Treatment is normally carried out by administering medication. These are associated with severe side effects, so that the quality of life of the affected person is limited. In some cases, no relief of the symptoms is achieved despite all efforts. The patient often has to undergo dialysis to ensure his survival. In the further course, the patient needs the transplantation of a donor organ. Kidney transplantation is associated with special risks. The donor organ is not always successfully accepted by the organism. In addition, even under optimal conditions, long-term medication must be taken and regular check-ups must be performed. Furthermore, the structuring of everyday life must be adapted to the physical conditions.
Prevention
Because lupus nephritis is one of the autoimmune diseases that mostly have their cause in genetic predisposition, it is difficult to prevent specifically. However, everyone can take care to keep themselves and their immune system as healthy as possible. A healthy diet, low stress, sufficient sleep, and avoidance of nicotine or cosmetics containing plasticizers can have a great effect here.
Aftercare
Lupus nephritis can lead to various complaints and complications, so the person affected by this disease should definitely see a doctor at an early stage. Thereby, an early diagnosis always has a very positive effect on the further course of the disease and can also prevent further complaints. Most of those affected suffer from severely swollen legs as a result of lupus nephritis. This also leads to restrictions in movement and thus to significant limitations in the daily life of the affected person, which is why many patients are dependent on help from friends and relatives. There may also be a strong urge to urinate at night, which can have a very negative effect on the sleep of the affected person. Those affected are irritable and dissatisfied, which can even lead to depression and other psychological upsets. The further course of lupus nephritis depends very much on the exact causes of the disease, so that a general prediction is not possible. It is also possible that the life expectancy of the patient is reduced. As a rule, a stress-free daily routine and a healthy lifestyle have a positive effect on recovery.
What you can do yourself
What measures the affected person can take himself in the event of kidney inflammation depends, among other things, on the medical treatment and the doctor’s instructions. In principle, affected persons should take it easy. The actual treatment is tailored to the individual patient. In the acute phase of the disease, good attention should be paid to unusual symptoms and any side effects of the prescribed medication, so that the medication can be optimally adjusted. General measures such as a healthy diet, little stress, sufficient sleep and abstaining from alcohol, nicotine and other stimulants can support recovery. Those affected should also avoid cosmetics that contain plasticizers. If swelling occurs, cooling compresses or gentle massages can help. An increase in weight can be avoided by an adapted diet. If there is a nighttime urge to urinate, it may be necessary to use aids such as adult diapers. This is especially recommended during the acute phase of the disease, when temporary incontinence often occurs. After the acute lupus nephritis has subsided, the body may slowly be loaded again. In any case, a physician must monitor recovery.
