KIDNEY INVOLVEMENT
Lupus affecting the kidney is
sometimes said to be the most severe lupus involvement
with the organs.
In fact very many people with 'mild' lupus may also have
mild kidney involvement, which is treated accordingly.
Unfortunately it is true that serious kidney disease
usually requires the most powerful anti-lupus treatments
available.
However it is important to remember that lupus can almost
always be successfully treated and over 90%
of the patients live normal life spans.
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What are the signs that SLE is causing kidney disease?
As in most kidney diseases,
symptoms are rare in the early part of SLE affecting the
kidney.
When there is more inflammation in the kidney, there may
be abnormalities on testing the urine protein
(proteinuria) and blood (haematuria) may be found in the
urine, usually in small quantities that are only picked
up by testing.
In some cases the protein leak may be large enough to
cause nephrotic syndrome.
In more severe disease, blood pressure rises, blood tests
of kidney function become abnormal, and eventually the
amount of urine produced may fall and the kidneys
possibly fail completely.
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What sorts of kidney disease can SLE cause?
SLE can cause a wide range of
kidney diseases.
People can develop one of these, several together, or
they can progress from one to another.
So nephrotic syndrome
(marked by very high levels of protein in the urine and
low levels of protein in the blood along with swelling,
especially around the eyes, ankles and feet, and hands,
along with high cholesterol) may be caused by SLE;
but so may a severe crescentic *nephritis,
(also caused by vasculitis),
a severe and usually very acute type of kidney
inflammation causing leakage of blood proteins into the
urinary space and that requires
urgent treatment in order to save kidney function.
(*often with repeated plasmaphoresis
in combo with immunosuppressives)
If kidney failure occurs, dialysis and/or a kidney
transplant will be necessary.
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How can you tell what type of kidney disease SLE causes?
To find out exactly how SLE is
affecting the kidney, most people need a kidney biopsy .
This test involves the insertion of a needle into the
kidney by going through the back.
A tiny sample of kidney is removed and examined under a
microscope and by other special tests.
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What treatment is available for kidney disease in SLE?
Just as SLE and the kidney diseases
it causes are very variable, so the therapies that can be
used to treat it are very variable.
As SLE results from some abnormal activity of the body's
immune system, it seems logical to use therapy and
treatments that targets this system; this is called
immunosuppressive therapy.
Doctors will also pay attention to other issues as well
as specific therapy.
Amongst these, it is important to ensure that blood
pressure is well controlled along with any medication
sensitivities and/or allergies; infection, diet and
smoking are also addressed.
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What happens if therapy is not successful?
In many cases when systemic lupus
affects the kidneys, treatment does not cure the
condition, it just keeps it under control.
If treatment is stopped, the disease may get worse again.
In other cases, treatment is unable to undo the damage
done, and the kidneys deteriorate.
If this happens, kidney failure may occur.
If it does, good health can be regained by dialysis or by
kidney transplantation.
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