Your Kidneys Matter: Lupus and the Damage It Can Do
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Your Kidneys Matter: Lupus and the Damage It Can Do

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A presentation by nephrologist Joseph Lieber, MD at Elmhurt Hospital in Queens, NY on November 5, 2008.

A presentation by nephrologist Joseph Lieber, MD at Elmhurt Hospital in Queens, NY on November 5, 2008.

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Your Kidneys Matter: Lupus and the Damage It Can Do Your Kidneys Matter: Lupus and the Damage It Can Do Presentation Transcript

  • SYSTEMIC LUPUS The “classic” autoimmune disease
  • Statistics
    • Females are more at risk then males
    • Ratio of female to male risk is 10:1
    • Anyone can be affected
  • Many Organ Systems Involved
    • Skin
    • Joints
    • Nervous system
    • Lung
    • Blood
    • Kidney*
    • Heart
  • The Kidney
    • Filters blood
    • Excretes waste
    • Manages body chemicals
    • - Sodium (salt), Potassium, Calcium
    • Manages acid state of body
    • Blood Pressure
    • Keeps protein from leaking out
  • The Kidney
    • The kidney has high blood flow rates, prone to immune damage
    • This will cause inflammation and possibly scarring
  • Kidney Involvement When:
    • Body swelling
    • High blood pressure
    • Blood in urine
    • Abnormal body chemistry--too much acid, too much water, abnormal potassium, etc.
    • Foamy urine
    • Decreased kidney function
  • Both Kidneys Always Involved
    • Fillers (Glomeruli) and support structures are involved
    • Therefore called Glomerulonephritis
    • Recurrent urinary tract infections can be misdiagnosed as urinary infection when really inflammation
    • Will manifest with blood in urine (hematuria), and/or protein in urine (proteinuria)
    • If more then 3.5g of protein in 24hrs, we call this Nephrotic Syndrome
    • Blood proteins can drop, cholesterol and blood pressure can rise, and the kidney can scar
  • Best Way To Access:
    • Urine exam
    • Kidney function: Creatinine
    • Cholesterol
    • Protein levels
    • Blood pressure
    • Markers of inflammation
  • Markers of inflammation or immune function:
    • ANA double strand DNA
    • C3C4
    • ESR
    • CRP
  • Kidney biopsy is the best way to diagnosis and determine treatment of Lupus Nephritis. It tells the degree of inflammation and scarring present .
  • WHO Classifications - biopsy VI Scarred V Memberanous IV Diffuse Proliferative III Focal Proliferative II Mesangial I Normal
  • If no scarring, then treat all:
    • Inflammation
    • High Blood Pressure
    • Salt Retention
    • High Cholesterol
    • These treatments have been worked out by enrolling patients into well designed studies, where they have been treated ethically and with the utmost care.
    • Control blood pressure to normal level 120/80
    • Use ACE inhibitor and/or ARB
    • These also decrease protein leakage
    • PROTEIN SPILLAGE CAUSES KIDNEY SCARRING!!!
    • Lower cholesterol with statins
    • Get rid of salt and lower blood pressure with diuretics
    • We usually use all of these methods in concert
    • Decreasing inflammation will decrease scarring
    • Cortisone-Prednisone is base of regimen
    • Cyclophosphamide very critical - worked out through large studies at NIH
  • Treatments
    • Azathioprine-weaker
    • Mycophenalate- “Cellcept”
    • Cyclosporine
    • Prograf
    • Rituxiumab
  • Treat Before Scarring
    • Once scarring occurs, cannot reverse injury
    • One should not prophylactically treat patients without kidney disease who have lupus
    • By lowering blood pressure, cholesterol, etc., scarring can be decreased and non renal complications lessened.
  • How to Determine Which Medication to Administer
    • Use studies that compare and contrast
    • Determine if one treatment is better for a certain group of patients
    • Get involved with trials
    • YOU ARE NOT A GUINEA PIG!!!
  • Lupus has become a very treatable disease. Only good studies can make it more treatable.
  •  
  • THANK YOU Remember, being involved in good studies will help lupus therapy for you and everyone.