The information contained in this section has been procured from  John Hopkins Medicine , the Mayo Clinic and Lupus Corner.

It is all for educational purposes and not intended to be taken as medical advice.

What is Lupus Nephritis?

Lupus nephritis is a frequent complication in people who have systemic lupus erythematosus — more commonly known as lupus.

Lupus is an autoimmune disease. It causes your immune system to produce proteins called autoantibodies that attack your own tissues and organs, including the kidneys.

Lupus nephritis occurs when lupus autoantibodies affect structures in your kidneys that filter out waste. This causes kidney inflammation and may lead to blood in the urine, protein in the urine, high blood pressure, impaired kidney function or even kidney failure.

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Source: Mayo Clinic

Lupus Nephritis

Causes

As many as half of adults with systemic lupus develop lupus nephritis. Systemic lupus causes immune system proteins to damage the kidneys, harming their ability to filter out waste.

Source: Mayo Clinic

 

 

Four Major Types of Lupus

1. Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is the most common form of lupus. When people talk about lupus in general, this is the type they’re most likely referring to. SLE affects many organs, especially skin, joints and kidneys.

2. Lupus of the Skin

  There are three types:

  • Acute cutaneous lupus

  • Chronic cutaneous lupus erythematosus, or discoid lupus erythematosus (DLE). The main symptom of chronic cutaneous lupus erythematosus, or DLE, is a rash that can leave major scars. It’s typically on your face, neck and scalp, but may also be on or in your ears and, less frequently, on your upper torso. These scaly areas slowly expand at the edges and then heal, leaving discolored skin and sunken scars. DLE on your scalp can cause permanent hair loss. This type of lupus is more common in smokers and African-Americans.

  • Subacute cutaneous lupus erythematosus

A skin biopsy is sometimes necessary to diagnose these types of lupus, as each has its own characteristic lesions and patterns.

3. Chronic Cutaneous Lupus Erythematosus

The main symptom of chronic cutaneous lupus erythematosus, or DLE, is a rash that can leave major scars. It’s typically on your face, neck and scalp, but may also be on or in your ears and, less frequently, on your upper torso. These scaly areas slowly expand at the edges and then heal, leaving discolored skin and sunken scars. DLE on your scalp can cause permanent hair loss.

This type of lupus is more common in smokers and African-Americans.

4. Drug-Induced Lupus Erythematosus

This type of lupus is separate from SLE and is caused by taking certain prescription drugs. The presentation of drug-induced lupus is like SLE, including joints and inflammation around the lungs. The drugs most commonly connected with drug-induced lupus include:

  • Hydralazine: used (rarely) to treat high blood pressure or hypertension

  • Procainamide: used (rarely) to treat irregular heart rhythms

  • Isoniazid: used to treat tuberculosis

  • Minocycline: used to treat acne

  • Anti-TNF: used to treat rheumatoid arthritis, psoriatic arthritis and spondyloarthropathy

 

Source: John Hopkins Medicine

 

 

Neonatal Lupus Erythematosus

Neonatal lupus is a rare condition that affects babies of women who have anti-Ro and anti-La antibodies. These antibodies from the mother act on the baby’s heart conduction system. At birth, the infant may have a skin rash, liver problems or low blood cell count.

Source: John Hopkins Medicine

 

Symptoms and Signs of Lupus

Signs and symptoms of lupus nephritis include:

  • Blood in your urine

  • Foamy urine (due to excess protein in urine)

  • High blood pressure

  • Swelling in your hands, ankles or feet

  • High levels of a waste product called creatinine in your blood

  • Sores in your mouth or nose

  • Hair loss visible to others

  • Rash lasting for days to weeks in areas that have been exposed to the sun

  • Swollen or stiff joints, which may be worse in the morning

  • Chest pain with every deep breath, lasting more than 24 hours

  • Pale fingers that may become numb and tingle when exposed to cold or stress (Raynaud’s phenomenon)

  • Low blood counts

  • Fever

  • Weight loss

Source: Mayo Clinic

Source: John Hopkins Medicine

 

Who’s at the highest risk of developing lupus?

We do know who has a stronger chance of developing lupus:

  • Gender: Even though anyone can get lupus, it most often affects women. They’re nine to ten times more likely than men to develop it.

  • Age: Lupus can occur at any age, but most are diagnosed in their 20s and 30s.

  • Race: Lupus is two to three times more common in African-American women than in Caucasian women. It’s also more common in Hispanic, Asian, and Native American women. African-American and Hispanic women are more likely to have severe forms of lupus.

  • Family history: Relatives of people with lupus have a greater chance of developing lupus. Only about 2 percent of children whose mothers have lupus will develop it.

Source: John Hopkins Medicine

 

Testing

Several tests can help your doctor determine if you have lupus and — if you do have it — its severity. You will usually have the following tests. The details they gather are all pieces of the puzzle that can lead to a lupus diagnosis.

  • Complete blood count (CBC): checks for low counts of red blood cells, white blood cells and platelets.

  • Complement tests: measures the level of complement — proteins in your blood that help destroy foreign substances. Low levels of complement can indicate lupus.

  • Chemistry panel: assesses your kidney and liver functions.

  • Urinalysis and urine protein-to-creatinine ratio: assesses for lupus of the kidneys.

  • Lupus autoantibody tests: tests for anti-dsDNA, anti-Sm, anti-RNP, anti-Ro, anti-La, Coombs and antiphospholipid antibodies. 

 

Source: John Hopkins Medicine

 

 

Diagnosis

Tests to diagnose lupus nephritis include:

  • Blood and urine tests. In addition to standard blood and urine tests, you may be asked to collect your urine for an entire day. These tests measure how well your kidneys are working.

  • Kidney biopsy. A biopsy — where your doctor removes a small section of kidney tissue for lab analysis — is the most definitive test for diagnosing lupus nephritis. It can also help determine how severe your disease is.

Source: Mayo Clinic

Treatment

There's no cure for lupus nephritis. Treatment aims to:

  • Reduce symptoms or make symptoms disappear (remission)

  • Keep the disease from getting worse

  • Maintain remission

  • Avoid the need for dialysis or a kidney transplant

 

Source: Mayo Clinic

 

 

Current Treatments Available

 

The following are some of the medication-based treatments available:

  • Hydroxychloroquine: an antimalarial drug that is effective for treating lupus-related arthritis and rashes. It reduces flares by 50 percent and may also help prevent blood clots.

  • Corticosteroids and immune suppressants: often recommended for people with serious or life-threatening problems such as kidney inflammation, lung, heart or central nervous system lupus. This includes high-dose corticosteroids such as prednisone and drugs that suppress the immune system, such as azathioprine, cyclophosphamide, mycophenolate and methotrexate.

  • Biologics: target specific parts of the immune system instead of affecting many areas of the immune system. Belimumab is FDA-approved for treating lupus.

 

Source: John Hopkins Medicine

 

Immune suppressants

For severe lupus nephritis, you might take drugs that slow or stop the immune system from attacking healthy cells, such as:

  • Steroids, such as prednisone

  • Cyclosporine

  • Tacrolimus

  • Cyclophosphamide

  • Azathioprine (Imuran)

  • Mycophenolate (CellCept)

  • Rituximab (Rituxan)

 

When immunosuppressive therapies don't lead to remission, clinical trials may be available for new therapies.

Source: Mayo Clinic

 

Treatment options for kidney failure

For people who progress to kidney failure, treatment options include:

  • Dialysis. Dialysis helps remove fluid and waste from the body, maintain the right balance of minerals in the blood, and manage blood pressure by filtering your blood through a machine.

  • Kidney transplant. You may need a new kidney from a donor if your kidneys can no longer function.

Source: Mayo Clinic

 

Conservative treatments

In general, doctors may recommend these treatments for people with kidney disease:

  • Diet changes. Limiting the amount of protein and salt in your diet can improve kidney function.

  • Blood pressure medications. Drugs called angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) can help control blood pressure. These drugs also prevent protein from leaking from the kidneys into the urine. Drugs called diuretics can help you get rid of excess fluid.

However, conservative treatment alone isn't effective for lupus nephritis.

Source: Mayo Clinic

Other Treatments for Lupus-related Complications

Your doctors may prescribe other medications to treat problems that are common with lupus. Some of those include:

  • Anticonvulsants for seizures

  • Antibiotics for infections

  • Antihypertensive drugs for high blood pressure

  • Statins for high cholesterol

  • Drugs for osteoporosis

  • Vitamin D to help improve kidney lupus

Source: John Hopkins Medicine

Living with Lupus

Maintaining a healthy lifestyle can help manage your lupus symptoms. Here are a few easy ways to take care of yourself:

  • Eat a heart-healthy diet.

  • Maintain a healthy weight.

  • Exercise several times a week.

  • Reduce your sun exposure by staying out of the sun as much as possible, wearing clothes that cover your skin and using sunscreen of SPF 100.

  • See your doctor for infections.

  • Don’t smoke.

Source: John Hopkins Medicine

Lupus and Gluten

Gluten intolerance and celiac disease frequently coexist with lupus. In one survey, the percentage of people with autoimmune diseases and celiac disease was as high as 30% (with the general population having a rate of autoimmune disease ranging from 3-9.4%). However, most scientists do not believe that there is a causal link to lupus. 

Instead, people with these conditions might share genes or gene combinations that make them more susceptible to autoimmune diseases, allergies, and intolerances to otherwise harmless proteins. The length of time that a person is exposed to gluten doesn’t appear to have an effect, which supports this theory. 

A gluten-free diet also did not prevent autoimmune disease in a 2002 study. But, that doesn’t mean that gluten-free diets don’t have value to people with lupus.

Source: LupusCorner

 

Lupus and a Gluten Free Diet

For people with gluten intolerance or celiacs, gluten can cause flares, worsen symptoms, and trigger the onset of disease. Gluten is also known to affect the microbiome, the colonies of bacteria that call our gut home. This complex network is highly connected to lupus and other autoimmune diseases. Because it does affect these systems, a gluten free diet can potentially help people with lupus who also have gluten intolerances or sensitivities.

Source: LupusCorner

 

Is it Lupus or Celiac Disease?

Gluten intolerance can have both gut and non-gut-related symptoms. It can even be mistaken for SLE. because the inflammatory markers and symptoms can look almost exactly the same. This makes sense as both are caused by similar immune system issues firmly rooted in genetics.

In fact, this 2004 study provides a case where three different people presented symptoms that were diagnosed as lupus, but were really gluten sensitivity.

So how can you tell the difference?

Going on a gluten-free diet will help with an intolerance, but will have only a limited effect on lupus. Also, if you don’t have gluten intolerance, a restrictive diet won’t help very much with lupus. Figuring out your personal needs and tolerances is key.

Lupus medications will have less of an effect on gluten intolerance because they aren’t treating the core issue. 

Talk to your lupus treatment team if you suspect that you may be intolerant, have lupus, or potentially both. Figuring out what is going on with your body is the first step to finding the medical regimen – and diet – that is best for you. 

Source: LupusCorner

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