Lupus nephritis is inflammation of the kidneys caused by systemic lupus erythematosus (SLE). SLE, on the other hand, is an autoimmune disease that can affect not only the skin but also various organs or regions of the body. In patients suffering from lupus nephritis, the kidneys are affected.
What is lupus nephritis?
About 70 to 100 percent of people who have SLE also have lupus nephritis. According to histology, all SLE patients can also carry lupus nephritis, even if the clinical examinations do not yet show damage to the kidneys. The name is derived from the Latin words “lupus” (wolf) and “nephritis” (collective term for all inflammatory diseases of the kidneys). See AbbreviationFinder for abbreviations related to Lupus Nephritis.
The disease occurs in phases. After a flare-up 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 is 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.
As described above, lupus nephritis occurs in most patients suffering from systemic lupus erythematosus. This is an autoimmune disease that belongs to the so-called collagen diseases. This means that the body’s own immune system attacks its own connective tissue and triggers inflammation there.
As a rule, such diseases appear in middle age. Women are affected more often 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 medication can also trigger lupus nephritis.
Patients suffering from SLE should therefore always be tested for their kidney function in order to diagnose or rule out the possible presence of lupus nephritis. If left untreated, the disease can result in total kidney failure. Therefore, the earlier lupus nephritis is discovered, the better the prognosis for those affected.
Symptoms, Ailments & Signs
Lupus nephritis is a serious condition. Unfortunately, it’s not always easy to diagnose right away, as it can have a range of non-specific symptoms. However, the doctor should take a closer look if patients complain about swelling of the legs, especially the ankles.
Sometimes the hands or face can also swell. Other symptoms of lupus nephritis may include weight gain or high blood pressure. It is also suspicious if the urine is dark in color or foamy. Nocturnal urges to urinate can also indicate lupus nephritis.
Proteinuria, i.e. increased accumulation of protein in the urine, and microhematuria (blood in the urine that is not visible to the naked eye) should also make the doctor prick up his ears. In rare cases, lupus nephritis also shows gross hematuria, 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, stopping the medication temporarily can help clarify this.
Diagnosis & course of disease
If a patient has been diagnosed with SLE, the doctor will order a series of exams and tests to check kidney function. This includes 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.
The diagnosis is finally completed by the 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 the type of lupus nephritis. The severity and course of the disease vary from patient to patient, so no general statement can be made here.
In many cases, lupus nephritis cannot be diagnosed directly, so that early treatment is not possible in many cases and therefore does not take place. As a rule, however, those affected suffer from severe swelling in the legs and, in many cases, from restricted movement or pain.
Furthermore, the swelling can also appear on the hands or even the face, reducing the aesthetics of the person concerned. It is not uncommon for this to lead to reduced self-esteem or an inferiority complex. 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 kidney failure, which can also lead to the death of the person concerned. Treatment of this disease is carried out with the help of drugs. There are no particular complications and the disease usually progresses positively. However, the drugs can have serious side effects.
In severe cases, the patient is dependent on a kidney transplant or dialysis. This can sometimes lead to a reduction in the life expectancy of the patient.
When should you go to the doctor?
Consultation with a doctor is indicated as soon as symptoms and irregularities in urination appear. Discolouration of the urine, changes in the consistency of the urine or renewed urinary pressure immediately after going to the toilet must be examined and treated by a doctor. If the amount of urine decreases or fluid intake is refused, it is advisable to consult a doctor. If the person concerned wakes up repeatedly during the night because of the need to empty their bladder, this is considered unusual and should be monitored further.
If the symptoms persist for a long time, although there is no heavy fluid intake immediately before going to bed, the indications should be discussed with a doctor. If there is an unexplainable increase in body weight, a diffuse pain sensation inside the body or a general feeling of discomfort, a doctor’s visit is necessary to clarify the cause. If you feel ill or have any mental problems, you must consult a doctor.
If withdrawal behavior is noticed, participation in leisure activities decreases or mood swings occur, there is a need for action. Swelling, thickening of the legs and ankles are signs of health problems. A doctor’s visit should be made so that treatment can be initiated. If the person concerned suffers from mobility problems, a decrease in physical performance or an inner weakness, a comprehensive examination is recommended to clarify the symptoms.
Treatment & Therapy
Because lupus nephritis is so multifaceted, treatment is individually tailored for each patient. First, the doctor will try to control the disease with medication. The administration of corticosteroids can relieve an acute flare -up of inflammation.
Because these drugs can have serious side effects, the patient must be closely monitored. The dose is usually reduced as symptoms improve. Immunosuppressive drugs can also be used. They suppress the kidney-damaging activity of the immune system.
Cyclophosphamide, azathioprine or mycophenolate belong to the family of immunosuppressants. In some cases, blood thinners or antihypertensives are also given. However, drug therapy cannot always prevent further deterioration in kidney function. If total kidney failure occurs, the patient will need dialysis and, in extreme cases, even a kidney transplant.
Outlook & Forecast
The prognosis of lupus nephritis depends on the stage of the disease. In addition, the general state of health of the person affected is decisive for the further course of the disease. A cure is possible if the diagnosis is made at an early stage and the person affected does not suffer from any other diseases. If left untreated, irreparable kidney damage can occur.
In severe cases, the person concerned faces premature death. A similarly unfavorable course of the disease is given in patients in whom the disease occurs at an advanced stage. The particular challenge lies in an early diagnosis, since the symptoms are usually diffuse and a doctor is only consulted at a late stage.
Treatment is usually through the administration of medication. These are associated with strong side effects, so that the quality of life of those affected is restricted. In some cases, no alleviation of the symptoms is achieved despite all efforts.
The patient often has to undergo dialysis to ensure survival. In the further course, the patient needs a transplant of a donor organ. A kidney transplant is associated with special risks. The donor organ is not always successfully accepted by the organism. In addition, under optimal conditions, medication must be taken over the long term and regular check-ups must be carried out. The structuring of everyday life must also be adapted to the physical conditions.
Since lupus nephritis is one of the autoimmune diseases that are mostly caused by genetic predisposition, it is difficult to prevent it in a targeted manner. However, everyone can take care to keep themselves and their immune system as healthy as possible. A healthy diet, little stress, enough sleep and avoiding nicotine or cosmetics that contain plasticizers can make a big difference here.
Lupus nephritis can lead to various symptoms and complications, so the person affected with this disease should definitely consult a doctor at an early stage. An early diagnosis always has a very positive effect on the further course of the disease and can also prevent further symptoms. Most of those affected suffer from severely swollen legs due to lupus nephritis.
As a result, there are also limitations in movement and thus also significant limitations in the everyday life of those affected, which is why many patients are dependent on the help of friends and relatives. There can also be a strong urge to urinate at night, which can have a very negative effect on the sleep of the person concerned.
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. The life expectancy of the patient may also be reduced. As a rule, a stress-free everyday life and a healthy lifestyle have a positive effect on recovery.
You can do that yourself
Which measures the person concerned can take in the event of kidney inflammation depends, among other things, on the medical treatment and the doctor’s instructions. Basically, those affected should take it easy. The actual treatment is individually tailored to the patient.
In the acute phase of the disease, 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, enough sleep and avoiding alcohol, nicotine and other stimulants can support recovery. Those affected should also avoid cosmetics that contain plasticizers. If swelling occurs, cooling pads or gentle massages can help. Weight gain can be avoided with an appropriate diet.
In the case of nocturnal urges to urinate, it may be necessary to use aids such as adult diapers. This is particularly recommended in the acute phase of the disease, when temporary incontinence often occurs. After the acute lupus nephritis has subsided, the body can slowly be put under stress again. In any case, a doctor must monitor recovery.