Helen Brown
Lincoln College of Technology
11/3/12

Lupus of the Kidney

Jennifer Burns
ICD 9

Lupus Nephritis
Lupus is a chronic disease that can damage any part of the body skin, joints, and organs inside the body. Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In Lupus, something goes wrong with the immune system, which is the part of the body that fights off viruses, bacteria, and germs. Lupus is one of many disorders of the immune system known as autoimmune diseases. In autoimmune diseases, the immune system turns against parts of the body it is designed to protect. This leads to inflammation and damage to various body tissues. Lupus is a disease that can attack organs like the kidneys, heart and skin and this paper will focus on Lupus Nephritis which affects the organ of the kidneys. This paper will also give the latest research, stats and treatments available today to treat this disease.
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 end-stage renal disease (ESRD). People with ESRD need regular filtering of their body’s waste done by a machine (dialysis) or a kidney transplant so that at least one kidney is working properly. (lupus.org)
Lupus nephritis most often develops within the first five years after the symptoms of lupus start, and usually affects people between the ages of 20 and 40. It is estimated that as many as 40 percent of all people with lupus, 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 happen before you are diagnosed with lupus. (lupus.org)
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. Often the first signs of lupus nephritis show up in clinical laboratory tests on the urine. That is why testing the urine is so important.
Nephrologists are the physicians who treat the renal system. The tests they will use to diagnose lupus nephritis are: collection of urine, usually over a 24-hour period; blood tests; and often, a kidney biopsy. (lupus.org) Because the body’s waste matter is processed by the kidneys, testing a sample of the urine can show any problems with the way the kidneys are functioning. The most common tests look for cell casts and that is fragments of cells normally found in the blood, or fragments of the tubules of the kidneys and proteinuria which is protein being spilled into the body because the kidneys are not filtering the waste properly. (medscape./lupus.com) Certain blood tests can provide information about kidney damage and how well the body is filtering waste. The creatinine blood test is usually ordered along with blood urea nitrogen (BUN) test to assess kidney function. A combination of blood and urine creatinine levels may be used to calculate a creatinine clearance. This measures how effectively the kidneys are filtering small molecules like creatinine out of the blood. Serum creatinine measurements (along with the age, weight, and gender) are used to calculate the estimated glo-merular filtration rate (EGFR), which is used as a screening test for evidence of kidney damage. A kidney biopsy is done in a hospital. While the patient lies on their stomach the nephrologist will insert a very thin, long needle through the skin of the back