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.

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Your Kidneys Matter: Lupus and the Damage It Can Do

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

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