Lupus nephritis is an inflammation of the kidneys caused by systemic lupus erythematosus (SLE). SLE, on the other hand, is an autoimmune disease that, in addition to the skin, can also affect various organs or regions of the body. In patients with lupus nephritis, the kidneys are affected.

What is lupus nephritis?

About 70 to 100 percent of patients with SLE also have lupus nephritis. According to histology, all SLE patients can also carry lupus nephritis, even if the clinical studies have not shown any damage to the kidneys. The name derives from the Latin word "lupus" (the wolf) and "nephritis" (collective term for all inflammatory diseases of the kidneys).

The disease occurs in spurts. After the decay of a thrust, the skin of the lupus patients resembled by the scar-like depressions a wolf's face, so explains the name of the disease. In lupus nephritis is a glomerulonephritis, which is an abacterial (without detection of germs at the site of inflammation) inflammation, which usually affects both kidneys.

The glomeruli are small collections of vessels or nerves. In the kidneys, they are an essential part of the kidney bodies, which are responsible for the filtration of the urine. Left untreated, lupus nephritis can lead to total kidney failure.

causes

As previously described, lupus nephritis occurs in most patients suffering from systemic lupus erythematosus. This is an autoimmune disease that belongs to the so-called collagenoses. This means that the body's own immune system attacks its own connective tissue and triggers inflammation there.

As a rule, such diseases occur in middle age. Women are more affected than men. The exact cause of lupus erythematosus is unknown, but certain prevalent genetic factors favor the disease. Even external circumstances, such as hormonal changes, stress, other infections or even medications, can cause lupus nephritis.

Patients with SLE should always be tested for renal function in order to diagnose or rule out the possibility of lupus nephritis. If left untreated, total kidney failure can result. Therefore, the sooner lupus nephritis is detected, the better the prognosis for those affected.

Symptoms, complaints & signs

Lupus nephritis is a serious condition. Unfortunately, it is not always easy to diagnose her right away, as she may have a number of nonspecific symptoms. However, the doctor should look more closely when patients complain of swelling of the legs, especially the ankle.

Sometimes your hands or face can swell. Other symptoms of lupus nephritis can be an increase in weight or high blood pressure. It is also suspicious if the urine is dark discolored or frothy. Nocturnal urgency may also indicate lupus nephritis.

Proteinuria, ie an increased accumulation of protein in the urine, as well as a micro-hematuria (blood in the urine, which is not visible to the naked eye) should also alert the doctor. In rare cases, lupus nephritis also shows gross hematuria, which means there is so much blood in the urine that it can be seen without a microscope. Some medications given with lupus may also cause these symptoms, here a temporary withdrawal of the medication can bring clarity.

Diagnosis & disease course

If SLE is detected in a patient, the doctor will order a series of examinations and tests to check kidney function. This includes first a detailed medical history and physical examination. An ultrasound examination of the kidneys and various laboratory tests, which are common in kidney problems (blood and urine tests) also provide information.

Finally, the diagnosis is completed by 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 what type of lupus nephritis it is. The severity and course of the disease vary from patient to patient, so no general statement can be made here.

complications

In many cases, lupus nephritis can not be diagnosed directly, so early treatment is often impossible and therefore not possible. As a rule, those affected suffer from severe swelling of the legs and thus in many cases with restricted mobility or also with pain.

Furthermore, the swelling can also occur on the hands or even on the face, thereby reducing the aesthetics of the person concerned. Not infrequently this leads to reduced self-esteem or inferiority complexes. Furthermore, the lupus nephritis leads to nocturnal urgency, which can lead to depression and other mental upsets.

In the worst case, this disease leads to renal insufficiency, which can continue to lead to the death of the person affected. The treatment of this disease is done with the help of medication. Special complications do not occur and usually set in a positive course of disease. However, the medications can have strong side effects.

In severe cases, the person is dependent on transplantation of the kidney or on 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 occur. Discoloration of the urine, changes in the consistency of the urine or a renewed urinary pressure immediately after using the toilet should be medically examined and treated. If the amount of urine decreases or if you refuse to take fluids, it is advisable to consult a doctor. If the patient repeatedly arouses during sleep at night due to a necessary bladder emptying, this is considered unusual and should be monitored further.

If the symptoms persist for a long time, although there is no strong fluid intake immediately before bed rest, the advice should be discussed with a physician. If it comes to an unexplained increase in body weight, a diffuse pain experience inside the body or a general malaise, a visit to the doctor to clarify the cause is necessary. In case of a feeling of illness or mental abnormalities, the consultation with a doctor is necessary.

If a 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 discomfort. A doctor's visit should be made in order for treatment to be initiated. If the person suffering from mobility problems, a decrease in physical performance or an internal weakness, it is recommended to investigate the symptoms of a comprehensive investigation.

Treatment & Therapy

Because lupus nephritis is so diverse, treatment is tailored to the individual patient. First, the doctor will try to control the disease with medication. The administration of corticosteroids can relieve an acute inflammatory thrust.

Since these drugs can have serious side effects, the patient must be closely monitored. As a rule, the dose is reduced as soon as the 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. Furthermore, in some cases, blood thinners or antihypertensives are given. However, drug therapy can not always prevent further deterioration of kidney function. Should it come to total kidney failure, the patient requires 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 takes place at an early stage and the person is suffering from no further illnesses. If left untreated, irreparable kidney damage may result.

In severe cases, the person threatened premature death. A similarly unfavorable course of disease is present in patients in whom the disease takes place at an advanced stage. The particular challenge is to make an early diagnosis, since the symptoms are usually diffuse and a doctor is consulted late.

The treatment usually takes place through the administration of medication. These are associated with strong side effects, so that the quality of life of the person affected is limited. In some cases, despite all efforts, no relief of the symptoms is achieved.

Often, the patient must have dialysis to ensure his or her survival. In the further course, the patient needs the transplantation of a donor organ. A kidney transplant involves special risks. The organ of donation is not always accepted successfully by the organism. In addition, long-term medication must be taken under optimal conditions and regular follow-up examinations be carried out. The structuring of everyday life is also adapted to the physical conditions.

prevention

Since lupus nephritis is one of the autoimmune diseases mostly caused by genetic predisposition, it is difficult to specifically prevent it. However, every person can take care to keep himself and his immune system as healthy as possible. A healthy diet, little stress, sufficient sleep, and abstinence from nicotine or cosmetics that contain plasticizers can do a lot here.

aftercare

The lupus nephritis can lead to various ailments and complications, so that the person affected in this case, in any case, early on to see a doctor. An early diagnosis always has a very positive effect on the further course of the disease and can also prevent further symptoms. Most sufferers suffer from lupus nephritis on heavily swollen legs.

Therefore, there are also restrictions in the movement and thus also significant restrictions in the everyday life of the person affected, which is why many patients are dependent on the help of friends and relatives. Likewise it can come to a strong nightly urination, which can have a very negative effect on the sleep of the person concerned.

Those affected are irritated and dissatisfied, which can even lead to depression and other mental upsets. The further course of the lupus nephritis depends very much on the exact causes of the disease, so that a general prediction is not possible. It may also reduce the life expectancy of the patient. As a rule, a stress-free everyday life and a healthy lifestyle has a positive effect on recovery.

You can do that yourself

Which measures the person concerned can take in case of nephritis depends, among other things, on the medical treatment and the instructions of the doctor. Basically, sufferers should take care. The actual treatment is individually tailored to the patient.

In the acute phase of the disease, attention should be paid to unusual symptoms and possible side effects of the prescribed medication, so that the medication can be optimally adjusted. General measures such as a healthy diet, low stress, sufficient sleep and the renunciation of alcohol, nicotine and other stimulants can support recovery. Those affected should also refrain from using cosmetics containing plasticizers. If swelling develops, cool pads or gentle massages can help. An increase in weight can be avoided by an adapted diet.

At night urination may be necessary to use aids such as adult diapers. This is especially recommended in the acute phase of the disease, in which there is often a temporary incontinence. After the acute lupus nephritis has subsided, the body may be slowly charged again. In any case, a doctor must monitor recovery.

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