6 risk factors of lupus nephritis

lupus nephritis
The six risk factors for developing lupus nephritis include the following.

Risk factors for developing lupus nephritis include the following:

  1. Ethnicity: If you are African American, Hispanic or Latino, or Asian American.
  2. Gene: Those with the APOL-1 gene have an increased risk of developing kidney disease and lupus nephritis.
  3. Gender: Lupus nephritis is more common in men than in women although lupus itself is common in women.
  4. Age: Lupus nephritis is more common if you have had the first symptom of lupus as a child. Compared to adults with lupus (5 out of 10 get lupus nephritis), about 8 of 10 kids with lupus progress to lupus nephritis.
  5. Family history: If a family member has lupus nephritis, you are at a higher risk of the ailment.
  6. Lupus resistant to treatment: If your lupus does not respond to first-line treatment (steroids) and requires other immunosuppressive drugs, you are more likely to develop lupus nephritis in subsequent years.

How do I know if I have lupus nephritis?

If you suffer from systemic lupus erythematosus, you should proactively watch out for symptoms of developing kidney disease. Many times, there may be no symptoms, and the only clue is abnormal urine examination and raised blood creatinine and urea levels.

The symptoms of lupus nephritis (if present) include:

The urine analysis shows:

  • Microalbuminuria: Presence of albumin in the urine, which is 30 to 300 mg/dL in a 24-hour urine sample.
  • Frank proteinuria: Routine urine examination shows the presence of protein. Normal urine does not have any protein.
  • Red blood cells: Present of occult or frank blood in the urine is suggestive of ongoing kidney damage.
  • Cast cells: Urinary casts are seen under a microscope. These are made of white blood cells, red blood cells, shed kidney cells, and protein or fat.

The blood tests show:

  • Serum creatinine: Elevated serum creatinine for the given age and gender.
  • Serum urea: Elevated blood urea levels are seen. A steady rise in urea levels must be further investigated.
  • Serum electrolytes: Serum sodium and potassium abnormalities in the blood indicate acute kidney dysfunction and often warrant hospitalization.

Healthcare professionals extrapolate blood creatinine levels to estimate the glomerular filtration rate, which should be tracked every three to six months or more often if needed.

The kidney biopsy shows:

The final diagnosis in lupus nephritis is given by a pathologist who examines a piece of kidney tissue under a microscope. This helps the nephrologist (kidney specialist) to find out how far the disease has progressed, the type of lupus nephritis and initiate treatment accordingly.

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7 ways to prevent lupus nephritis

Lupus nephritis is one of the manifestations of systemic lupus erythematosus, and it exhibits a complex mechanism of progression.

The development of lupus nephritis depends on your ethnicity, response to lupus treatment, lifestyle, and environmental factors. Hence, it is difficult to predict and prevent lupus nephritis. However, with the right monitoring and prophylactic (preventive) interventions, the doctor can delay the onset of lupus nephritis.

The mainstay of renal protection therapy in lupus patients includes:

  1. Aggressive management of lupus: If lupus is resistant to steroid therapy, aggressive immunosuppression must be maintained for years. This step often delays lupus nephritis by many years.
  2. Sodium restriction: Lowering your sodium intake to about 1500 mg per day is associated with healthier kidneys. Stay away from salted chips, fries, as well as ready-to-eat and fast foods if you are already diagnosed with lupus.
  3. Water intake: Discuss with your nephrologist about your recommended water intake in a day. The advised six to eight glasses of water may not be a right fit for those who have kidney disorders. Monitor your fluid intake and drink just enough water to ensure your kidneys are well flushed.
  4. Protein restriction: Protein restriction is a cornerstone of delaying kidney damage in those with lupus nephritis. Your daily protein consumption should be about 1.3 to 1.6 mg per pound of body weight. Higher consumption of proteins is associated with an increased rate of damage to renal tubules and renal scarring at the microscopic level.
  5. Weight reduction: Obesity is associated with a pro-inflammatory state that accelerates glomerulopathy and proteinuria. Weight reduction under professional supervision with proper dietary interventions is encouraged. Avoid any herbal supplements, crash diets, ketogenic diets, herbal teas, or weight loss pills.
  6. Smoking cessation: Small-scale studies have reported that cigarette smoking hastens albuminuria and hypertension, the development of cardiovascular disease, and renal disease progression in patients with lupus.
  7. Avoid painkillers: Painkillers act by inhibiting chemicals called prostaglandin in the body. However, many prostaglandins are renoprotective and help with the blood supply to renal tubules and cell regeneration. Inhibition of these prostaglandins can hasten kidney failure.

6 ways to monitor kidney status in people with lupus

  1. 24-hour urine collection for creatinine clearance: Compares the amount of creatinine in the blood to the amount in your urine over a 24-hour period, which indicates how fast your kidneys clear creatinine. Your doctor may prescribe this test every three to six months to check your kidney status.
  2. 24-hour urine collection for protein or microalbumin: Because microscopic proteinuria is a major and modifiable risk factor for the progression of any kidney disease, screening for microscopic quantities of proteins is paramount. Measuring microscopic or frank proteinuria every two to three months in people with lupus nephritis is a must. If you are being treated with immunosuppressive drugs, proteinuria is measured more frequently. Once detected, starting medications, such as angiotensin-converting enzyme inhibitors, will help curb proteinuria and slow down kidney damage. Depending on your reports, the doctor may start other renoprotective medications, such as calcium channel blockers, beta-blockers, or angiotensin receptor blockers.
  3. Aggressive blood pressure control: Maintaining blood pressure to less than 125/75 mmHg delayed progression of lupus nephritis to end-stage renal failure by about 1.24 years. Hence, regular blood pressure monitoring and proactive treatment are a must.
  4. Lipid control: A lower low-density lipoprotein level (below 100 mg/dL) in people with lupus helps maintain optimal kidney health. Initiation of statins helps treat hyperlipidemia, improves blood supply to kidney tubules, and delays renal cell damage.
  5. Vitamin D supplementation: Many studies have reported that a reduced 25-hydroxy vitamin D is associated with an acceleration of kidney damage. Regular screening and treatment with active vitamin D (calcitriol) have been demonstrated to be effective in reducing mortality in many patients with chronic kidney disease.
  6. Screening for uric acid: Regular screening and treatment of hyperuricemia help delay the onset of lupus nephritis according to many small-scale studies.

How long can you live with lupus nephritis?

About 10 to 30 percent of those who suffer from lupus nephritis eventually progress to kidney failure or end-stage renal disease (ESRD). Compared to those with healthy kidneys, patients with renal disease, renal damage, and ESRD with lupus had about 2.2 to 9.2 times higher risk of death. This is because those with lupus nephritis are susceptible to certain cancers, cardiovascular diseases, electrolyte imbalances, and strokes compared to the average population.

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Medically Reviewed on 3/16/2022
References
Image Source: iStock Images

National Institutes of Health. Lupus and Kidney Disease (Lupus Nephritis). https://www.niddk.nih.gov/health-information/kidney-disease/lupus-nephritis

American Kidney Fund. Lupus nephritis: Symptoms, treatment and complications. https://www.kidneyfund.org/all-about-kidneys/other-kidney-diseases/lupus-nephritis-symptoms-treatment-and-complications

Tamirou F, Houssiau FA. Management of Lupus Nephritis. J Clin Med. 2021;10(4):670. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916202/

Parikh S, Hebert L, Rovin B. Protecting the kidneys in lupus nephritis. Int J Clin Rheumatol. 2011; 6(5), 529-546. https://www.openaccessjournals.com/articles/protecting-the-kidneys-in-lupus-nephritis.pdf