The Lupus Foundation of America (LFA) put out a release this month containing the estimate that as many as 40 percent of all people with lupus (SLE), and as many as two-thirds of all children with lupus, will develop kidney complications that require medical evaluation and treatment. Because there are so few symptoms of kidney disease, significant damage to the kidneys can occur before a person is actually diagnosed with lupus.
March is "National Kidney Month" and the LFA is using the observance to call attention to this serious and potentially life-threatening complication of lupus.

Lupus nephritis is the term used when lupus causes inflammation in the kidneys, making them unable to properly remove waste from the blood or control the amount of fluids in the body. Abnormal levels of waste can build up in the blood, and edema (swelling) can develop. Left untreated, nephritis can lead to scarring and permanent damage to the kidneys and possibly (the euphemistically named) end-stage renal disease (ESRD). People with ESRD need regular dialysis to filter of their body’s waste, or a kidney transplant so that at least one kidney is working properly. This occurrence greatly affects the person’s quality of life and life expectancy.

In the early stages of lupus nephritis, there are very few signs that anything is wrong. Often the first symptoms of lupus nephritis are weight gain and puffiness in the feet, ankles, legs, hands, and/or eyelids. This swelling often becomes worse throughout the day. Also, the urine may be foamy or frothy, or have a red color.

Diagnosis
Often the first signs of lupus nephritis show up in clinical laboratory tests on the urine. That is why a urine test, or urinalysis, is an important screening tool. In addition, certain blood tests can provide information about kidney damage and how well the body is filtering waste. A physician also may order a kidney biopsy in which a tiny piece of tissue from one of the kidneys is removed for testing.


Treatments
LFA notes that there are effective treatments for lupus nephritis. Prednisone and other corticosteroids are generally prescribed to stop the inflammation. The big ticket (yay, lupus is a market!) immunosuppressive drugs may also be used (with or in place of steroid treatments), such as cyclophosphamide ("Cytoxan" ka-ching), azathioprine ("Imuran" check-or-charge?), cyclosporin A, and mycophenolate mofetil ("CellCept" su-casa-es-mi-casa). Medications developed for other illnesses are also being studied as treatments for lupus nephritis, including rituximab (Rituxan®), eculizuimab (Soliris™), and abetimus sodium (Riquent™).



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