Lupus and your kidneys

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Lupus and your kidneys

  1. 1. Lupus and the kidney Suzanne El-Sayegh, MD Associate Chairman of Medicine Director of Nephrology Staten Island University Hospital
  2. 2. Lupus and the kidney <ul><li>SLE is a systemic disease </li></ul><ul><li>Affects all organs </li></ul><ul><li>Kidney disease is common </li></ul><ul><ul><li>Can affect up to 50% of patients </li></ul></ul><ul><ul><li>Kidneys have high blood flow: high exposure to preformed antibodies </li></ul></ul><ul><ul><li>Male patients, certain ethnic group are more at risk </li></ul></ul>
  3. 3. Lupus and kidney disease <ul><li>Called also lupus nephritis </li></ul><ul><ul><li>Inflammation of kidneys </li></ul></ul><ul><ul><li>Can be treated with medications with resolution </li></ul></ul><ul><ul><li>Or can lead to scarring and fibrosis </li></ul></ul>
  4. 4. Manifestation of disease <ul><ul><li>Could be silent </li></ul></ul><ul><ul><li>Blood in the urine ( that the patient can not see) </li></ul></ul><ul><ul><li>Protein in the urine ( foamy urine) </li></ul></ul><ul><ul><li>High blood pressure </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Renal failure </li></ul></ul>
  5. 5. <ul><li>Since disease could be silent: </li></ul><ul><ul><li>All patients need follow/up with their physician to check BP and to examine the urine for blood and protein </li></ul></ul>
  6. 6. Lab tests <ul><li>In order to know if lupus is active in the kidneys we can order some blood tests: </li></ul><ul><ul><li>Anti DNA will be elevated </li></ul></ul><ul><ul><li>Complement level ( c3, c4, ) might be low </li></ul></ul><ul><ul><li>ESR could be high </li></ul></ul><ul><ul><li>Urinalysis: blood , protein , RBC cats </li></ul></ul>
  7. 7. Kidney biopsy <ul><li>Always indicated: why? </li></ul><ul><ul><li>Define the staging </li></ul></ul><ul><ul><li>Determine the therapy </li></ul></ul><ul><ul><li>Assess prognosis </li></ul></ul><ul><ul><li>Assess chance of recovery </li></ul></ul>
  8. 8. Treatment <ul><li>Therapy is divided into standard therapy and specific therapy to target the lupus in the kidneys: </li></ul><ul><ul><li>Standard therapy: </li></ul></ul><ul><ul><ul><li>Control blood pressure </li></ul></ul></ul><ul><ul><ul><li>Control protein in the urine: use angiotensin converting enzyme drugs, or angiotensin receptor blockers </li></ul></ul></ul><ul><ul><ul><li>Might need to use diuretics ( water pills) </li></ul></ul></ul><ul><ul><ul><li>Might need to use medication to lower cholesterol specially in patients with heavy proteinuria </li></ul></ul></ul>
  9. 9. <ul><li>Targeted therapy: </li></ul><ul><ul><li>Depends on the result of kidney biopsy </li></ul></ul><ul><ul><li>Include: induction phase and maintenance phase </li></ul></ul><ul><ul><li>Medications used: cyclophosphamide, mycophenolate mofetil, azathioprine, rituximab </li></ul></ul>
  10. 10. <ul><li>Prognosis depends on the kidney findings </li></ul><ul><li>If no response and renal function continues to deteriorate patient will require dialysis </li></ul><ul><li>Kidney transplant is an option </li></ul><ul><li>Pregnancy is not contraindicated however </li></ul><ul><ul><li>patients should be stable on low dose of prednisone, </li></ul></ul><ul><ul><li>lupus should not be active, </li></ul></ul><ul><ul><li>minimal protein in the urine </li></ul></ul><ul><ul><li>and good kidney function </li></ul></ul>

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