By Ellen Ginzler, MD
SUNY-Downstate Medical Center, Brooklyn, NY
What is lupus kidney disease?
In approximately one-third of people with lupus, the disease causes such notable inflammation in the kidney's filtering units (glomeruli) that blood toxins and waste don't get properly processed, and medical treatment is required. Called lupus nephritis, or lupus glomerulonephritis, this condition must be very carefully watched since the kidneys are so important to overall health. In addition to filtering wastes, the kidneys balance body fluids and regulate hormones that control blood pressure, among other functions. Intensive drug treatment is often necessary to prevent permanent damage.
How can a person with lupus determine if the kidneys are having problems?
Unfortunately, no single or simple test shows how the kidney (renal) system is doing. And while some people notice discomfort in their side, dark urine, weight gain from extra fluid, and swelling (around eyes, hands, feet), many don't notice any specific symptoms. To be careful, kidney function in all people with lupus should be regularly monitored for the presence of protein in the urine (proteinuria), or high levels of urea or creatinine in the blood. High blood pressure also can signal that the kidneys are under stress.
What is done to treat lupus kidney disease?
Many people with lupus have mild kidney problems that don't necessitate treatment other than careful monitoring and sensible lifestyle measures such as restriction of salt intake (ideally to less than 3 grams daily) and stress reduction. Blood pressure that is high should be aggressively treated, however, because it can accelerate kidney damage along with causing other health problems. High blood pressure usually is treated with medications such as diuretics, which help remove fluid and can increase comfort.
What happens if the kidneys fail?
Despite vigilance on the part of the patient and doctor, lupus still sometimes leads to kidney failure. Once it's confirmed that lupus is to blame for kidney function deterioration, a careful treatment strategy should be formulated based on renal function, amount of inflammation, and the results of blood and urine tests. Sometimes a small amount of kidney tissue (a biopsy) is taken to directly measure kidney status. Advanced stages of kidney failure signaled by the presence of urea and certain other wastes in the blood (uremia) often require kidney dialysis or transplantation.
What are the primary areas of research in lupus?
With no major new treatment approved in more than 40 years, lupus needs a breakthrough. Researchers have made significant headway over the past few years, reporting new findings on how and why the disease develops and what can be done about it. Among the advances are a deeper understanding of how the disease is sometimes passed on through generations and greater insight in to how lupus attacks the brain, heart, kidneys, and skin.
Are companies developing new drugs to treat lupus?
Yes, finally. Several pharmaceutical companies are developing new medications. An online search will generate information on these companies and their drugs. You also can find websites that report new drug findings, such as www.LupusNY.org and www.LupusResearchInstitute.org.
How can I help advance research and drug development?
As a person with lupus, you can directly help in advancing lupus science—and at the same time help yourself—by participating in a research project called a clinical trial. These trials evaluate the safety and effectiveness of medical treatments, drugs, or devices in human beings. The Food and Drug Administration (FDA) requires that such trials be performed before a product is prescribed to patients.
In addition, many lupus centers conduct so-called "observational studies" designed to follow the natural progression of the disease and gain better understanding of how lupus affects different organs. These types of studies do not involve any medications; you're seen by the physician several times a year and may be asked to give extra blood samples or have certain tests done. Many scientific advances have come from these types of studies. For more information on all kinds of lupus studies, try visiting the following websites: www.clinicaltrials.gov; www.LupusResearchInstitute.com; www.centerwatch.com.
What is the outlook for people with lupus?
There isn't a cure yet, but every year researchers get better insights into lupus and come closer to uncovering more specific and less toxic treatments. In 1955, only 50 percent of people newly diagnosed with lupus were expected to live more than four years. By 1969, that figure for 50 percent survival extended past four years to10 years. Now most people with lupus can look forward to a normal lifespan.