Nephritis - body, causes, Pollys Sore Throat, What Is Nephritis? Nephritis Nephritis Nephritis (nef-RY-tis) is an inflammation of one or both kidneys that can result in kidney damage. KEYWORDS for searching the Internet and other reference sources Bright's disease Renal disease Polly's Sore Throat Polly will always remember fifth grade because she missed so much of it. She missed one week of school because she had strep throat, a sore throat caused by streptococcal bacteria. Several weeks later, Polly felt very tired, she lost her appetite, her abdomen and back hurt, and her face looked puffy. She rarely had to urinate, and when she did, her urine was dark like cola. Polly's doctor suspected that she had a case of acute (sudden) nephritis that was caused by her strep throat. He explained that her kidneys were not working properly and that waste products from the cells were building up inside her body. Polly's condition got worse. She spent several days in the hospital, then she recovered at home for several weeks. What Is Nephritis?

The kidneys play an important role in filtering about 400 quarts of blood a day to remove cellular waste products and extra water. Each of the two bean-shaped kidneys is made up of about one million units called nephrons (NEF-rons). Each nephron consists of a collecting tubule that will eventually take wastes to the bladder, and a filtering unit called a glomerulus * . * glomerulus (glom-ER-you-lus) is from a Greek word meaning "filter." The glomerulus is a knot of blood vessels that have the job of filtering the blood. 175 Years Ago: Richard Bright Richard Bright, a British physician who lived from 1789 to 1858, was the first to describe the kidney disorder known today as Bright's disease, or nephritis. Bright studied kidney function and was meticulous in his clinical observations. He worked with kidney patients, studying their symptoms, and then he correlated symptoms with the kidney defects he observed during autopsies (examinations after death). The results of Bright's research first appeared in Reports of Medical Cases in 1827. Bright also contributed to the study of lung disease, heart disease, various fevers, and tumors.

In a person with nephritis, the glomeruli (plural of glomerulus) do not function properly, often as a result of a bacterial infection like Polly's. Not all the glomeruli are damaged to the same degree, however, so the kidneys can continue to function, but not as well as before. The kidneys may already be affected before the person notices symptoms. Glomerulonephritis (Bright's disease) There are several different types of nephritis. One of the most common is glomerulonephritis (glomer-u-lo-ne-FRY-tis), also called Bright's disease, a condition in which the glomeruli become inflamed and scarred. Common symptoms of this disease include tiredness, high blood pressure, and swelling of the hands, feet, ankles, and face. This swelling is called edema (e-DEE-ma). The person will pass blood and protein in the urine. Acute nephritis Another type of nephritis that commonly affects children occurs as a result of infection. Sometimes a bacterial infection can spread from another part of the body, such as the bladder, to the kidney.

The body's disease-fighting proteins, or antibodies, can adhere to the glomeruli, causing them to become inflamed. This type of nephritis usually is acute, or sudden, and many affected children recover without long-term kidney damage. Other causes Nephritis can occur as a side effect of other diseases, such as diabetes * , and of autoimmune disorders such as systemic lupus erythematosus * . Nephritis also can be caused by the overuse of certain common drugs, such as ibuprofen (i-bu-PRO-fen) and acetaminophen (a-set-a-MIN-a-fen), and by sniffing glue or inhaling gasoline. What Happens When People Have Nephritis? Symptoms Acute nephritis is characterized by fatigue, loss of appetite, abdominal and back pain, and edema. People with chronic nephritis might not show any outward symptoms. However, protein and red blood cells can usually be seen when a doctor examines their urine under a microscope. If left untreated, chronic nephritis may cause a drastic reduction in kidney function, and the patient's kidney tissue will deteriorate. The patient may develop high blood pressure and may die either from kidney or heart failure.

Treatment To treat acute nephritis, the doctor may prescribe anti-biotics to treat infection, anti-inflammatory drugs to reduce symptoms of inflammation, and diuretics to reduce edema. Chronic nephritis cannot be cured, but it can be treated. The goal of treatment is to slow the deterioration of the kidneys. Drugs may be used to treat high blood pressure and a special diet may be prescribed to relieve the load on the kidneys. People with an overactive immune system that triggers nephritis may be given immunosuppressant drugs to slow down the attack on the kidneys by the immune system. * diabetes (di-a-BEE-teez) is an impaired ability to break down carbohydrates, proteins, and fats because the body does not produce enough insulin or cannot use the insulin it makes. * systemic lupus erythematosus (sis-TEM-ik LOO-pus er-i-them-a-TO-sus), sometimes just called lupus, is a chronic inflammatory disease that can affect the skin, joints, kidneys, nervous system, membranes lining body cavities, and other organs. Nephritis can lead to kidney failure, in which case dialysis or a kidney transplant is required.

Dialysis is a procedure in which blood is passed through a machine to filter out waste products and extra water, then returned to the person's body. A kidney transplant is a procedure in which a diseased kidney is surgically replaced with a healthy kidney from a compatible donor. See also Molly's Fund Living With Lupus: In What Ways Can Lupus Affect the Body? Living With Lupus: How Can Lupus Affect the Body? In Lupus and other autoimmune diseases , the immune system begins to recognize and attack itself, going after and injuring healthy tissue. This can cause several complications as well as inflammation throughout the body’s various systems. Because lupus can affect nearly every part of your anatomy, it is a difficult disease to diagnose , predict the progress of, and treat. There are several emotional ramifications when coping with lupus, which is discussed in more detail in our blog, Coping With Lupus:How does lupus affect your state of mind and body? For the purposes of this blog, we will focus specifically on the physical ramifications that may occur in the body affected by lupus. It is also quite common to have lupus in combination with other connective tissue or autoimmune diseases .

When this occurs, it is often called an overlap disease . This is one of the main reasons that lupus can be so difficult to diagnose and, all too often, misdiagnosed. *It is important to note that no two lupus patients are alike. While some may get certain symptoms of lupus , others will not get those same symptoms. Developing a strong relationship with your doctor is vital so that you may work together to create the most effective treatment plan specific to your needs. Back to top Lupus Effect on the Body: A Head to Toe Listing Brain and Nervous System: People with lupus often experience signs associated with the body’s brain and nervous system. This can affect both the central nervous system (brain and spinal cord) and the peripheral nervous system. Complications from this can cause headaches, depression, mood swings, cognitive dysfunction (brain fog) , stroke and seizures. Many of these symptoms can be successfully treated and/or managed with medication. Opthalmologic (The Eyes): The eye complications that can occur include; dry eye, blocked tear ducts, cataracts, blurred vision, impaired vision or even vision loss.

These can be related to the inflammatory process of lupus itself but in other cases, problems may be due to drug treatment ( corticosteroids or antimalarials ) or may be a separate problem (glaucoma or retinal detachment). It is very important to schedule annual comprehensive eye exams to catch and treat any issues that may come about. Dermatologic (The Skin): There are three major types of skin disease specific to lupus: Discoid Lupus , Subacute Cutaneous Lupus and Acute Cutaneous Lupus . For more information on this topic, please read our blog on the butterfly rash and other rashes. Approximately two-thirds of people living with lupus will develop some type of skin disease or cutaneous lupus. Rashes and sores are a common complication of lupus.

Up to 70 percent of lupus sufferers have photosensitivity (sensitive to ultraviolet, UV, light.) Some tips on mitigating the negative effects of lupus on the skin are: Avoiding direct exposure to sunlight or even some fluorescent light Stay out of the sun during the most intense times of the day, 10am-3pm Stay covered when out in the sun by wearing a wide brimmed hat, long-sleeved clothing and long pants Wearing sunscreen that has SPF of thirty or above Hematologic (The Blood): Approximately 50 percent of lupus patients with active lupus have anemia (too little hemoglobin, a protein that moves oxygen throughout the body). Still others can develop leukopenia (an abnormally low level of white blood cells) or thrombocytopenia (decreased number of platelets that aid in blood clotting) or thrombosis which can cause very dangerous blood clots. The Cardiopulmonary System: This includes your heart and lungs. A very important point to note- cardiovascular disease (heart disease), a common symptom of lupus, is the number one cause of death in people with SLE.

About 50% of people with SLE will experience lung involvement during the course of their disease. Five main lung problems occur in lupus: Pleuritis (inflammation of the membrane lining of the lungs) Acute Lupus Pneumonitis Pulmonary Hypertension “Shrinking Lung” Syndrome. Pleuritis is the most common of these, causing sharp, stabbing pains in your chest upon breathing deeply, coughing, sneezing, or even laughing.Therefore, the proper monitoring and maintenance of optimal cardiovascular health is essential for those with lupus. The Renal System (Kidney): 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. This is called lupus nephritis . If you experience swelling in your feet, legs, fingers, or eyes; blood in your urine or increased frequency in urination especially during the night, it could signify inflammation in your kidneys that, if not treated, can lead to kidney damage and kidney disease. The kidney is the most extensively studied organ that is affected by lupus.

The Gastrointestinal System (GI system): GI system complications and problems from the esophagus to the intestines are a common occurrence in lupus patients. This can include the surrounding organs such as the stomach, liver, pancreas, bile ducts, and the gallbladder. Often the muscles aren’t able to effectively move waste through the intestines causing many of these digestive problems. The Musculoskeletal System: More than 90 percent of people with SLE will experience joint and/or muscle pain at some time during the course of their illness. Inflammation of the joints and muscles is the most common cause for this complication. Lupus Arthritis is recognized as pain, stiffness, swelling and a feeling of warming in your joints. The arthritis seen in lupus closely resembles rheumatoid arthritis (read more about “overlap” diseases below.) Although pharmaceutical medications are available for pain management, many patients find relief in natural remedies like moist heat, baths, showers, acupuncture, yoga, and chiropractic care. The Bones: The use of corticosteroid medication often prescribed to treat SLE can increase the risk for, and even trigger, significant bone loss or osteoporosis.

Getting enough calcium and vitamin D in your diet , regular exercise, and avoiding smoking can help combat the severity of any osteoporosis that may develop. Oral Disease in Lupus: Approximately 95 percent of lupus patients suffer from some form of oral complications such as the development of sores and lesions inside the mouth or nose. Canker sores can also become more prevalent. Topical steroids are often prescribed and can help alleviate these problems. Reproductive System: Pregnancy with lupus has always been considered “high-risk” due to the potential for an increased possibility of miscarriage or premature delivery. However, it is important to know that many women with lupus, receiving the proper monitoring and care of a physician, go on to deliver normal, healthy babies! Back to top In Conclusion While lupus is a lifelong disorder of the immune system with as of yet, no cure, there are treatments that can minimize the damage that lupus causes to the body. Increased education among the medical community and the public are leading to earlier diagnosis and strides are being made in the discovery of new lupus treatments which will, one day, lead to a cure.

Please join us in our mission to raise awareness for and help those who are living with lupus by sharing and commenting on this blog. And don’t forget- our newest blogs go out on the second and fourth Wednesday of every month. *All images unless otherwise noted are property of and were created by Molly’s Fund Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Molly’s Fund Fighting Lupus. **All resources provided by Molly’s Fund are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns. Hey, like this post? Why not share it with a buddy? Will Chronic Nephritis Affect Your Body Organs_Kidney Cares Community Will Chronic Nephritis Affect Your Body Organs 2015-01-23 09:28 There are many dangers of chronic nephritis.

If chronic nephritis can not get treatment for a long time, it will cause damages on other organs. What are harms of chronic nephritis on earth? Chronic nephritis can be divided into many types. Which type of nephritis you have should be decided through renal puncture. Nephritis has great harm to the body. If without correct or standard treatment, it will progress to kidney failure and uremia. Nephritis can cause many harms to human body and it can cause damages to digestive system, heart and skin. 1. digestive problems Experts point out that accumulated toxins will be drained into digestive tract. Bacteria in intestines will form ammonia under the function of urease. This will lead to fibrinous inflammation, resulting in ulceration and bleeding. 2. heart problems Heart problem is often to be seen in nephritis patients and meanwhile it is one of the serious complications. Chronic nephritis will lead to swelling of heart and lung. Since renal hypertension is on heart for a long time, it can cause heart failure and pulmonary edema. Cardiac failure is also one reason of death in people with chronic nephritis. 3. fluid and electrolyte imbalance Chronic Nephritis can also cause fluid and electrolyte imbalance.

For example, chronic nephritis will make insufficiency of erythropoietin and various toxins will prevent the hematopoietic function of bone marrow. In this condition, anemia can occur. In addition, intestinal tract will absorb less calcium so patients will suffer from hypocalcemia. Low blood calcium for a long time can lead to bone demineralization and patients will have muscle cramps, osteoporosis and bone pain as well as clinical symptoms. The above is the introduction of nephritis damages on human organs. If you have any question, you can contact our online doctor free of charge and our experts will give you detailed explanation. What is Nephritis? - RightDiagnosis.com What is Nephritis? Nephritis: Any type of kidney inflammation. Nephritis: an inflammation of the kidney. more types...» How serious is Nephritis? Average life years lost for Nephritis: 11.6 years for nephritis / nephrosis (SEER)1; 13.3 for nephritis / nephrotic syndrome / nephrosis in North Carolina2.

Deaths for Nephritis: 39,480 in USA 2001 (CDC) What causes Nephritis? Causes of Nephritis: see causes of Nephritis What are the symptoms of Nephritis?

Symptoms of Nephritis: see symptoms of Nephritis Nephritis: Testing Research for Nephritis: see research for Nephritis Society issues for Nephritis Hospitalization statistics for Nephritis: The following are statistics from various sources about hospitalizations and Nephritis: 0.015% (1,916) of hospital consultant episodes were for acute tubulo-intersititial nephritis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03) 80% of hospital consultant episodes for acute tubulo-intersititial nephritis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03) 17% of hospital consultant episodes for acute tubulo-intersititial nephritis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03) 83% of hospital consultant episodes for acute tubulo-intersititial nephritis were for women in England 2002-03 (Hospital Episode Statistics,

 Department of Health, England, 2002-03) 95% of hospital consultant episodes for acute tubulo-intersititial nephritis required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03) 5.2 days was the mean length of stay in hospitals for acute tubulo-intersititial nephritis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03) 3 days was the median length of stay in hospitals for acute tubulo-intersititial nephritis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03) Systemic Lupus Erythematosus Membranous Lupus Nephritis Mesangial Lupus Nephritis Systemic lupus erythematosus (SLE) is a disorder in which the immune system produces antibodies against the body’s own healthy cells and tissues (called autoantibodies).

These autoantibodies contribute to damage (inflammation) in various parts of the body such as the brain, the joints, the skin and the kidney. This damage alters the normal function of these different organs and tissues. When the inflammation affects the kidneys, it is called lupus nephritis or lupus glomerulonephritis. Glomerulonephritis refers to diseases that damage the filters or glomeruli of the kidney. Glomeruli are tiny structures composed of blood vessels that are responsible for filtering the blood of harmful or unnecessary substances. There a million glomerular filters within each kidney. In glomerulonephritis, inflammation of some or all of the glomerular filters reduces their ability to clear these substances out of the bloodstream. The damage also allows protein to leak into the urine and this is referred to as proteinuria or albuminuria. Red blood cells can also leak through the filters into the urine and is referred to as hematuria. Most individuals who are affected by lupus nephritis develop it early on after the diagnosis of SLE but it ca n develop at any time. It is unclear why some people with SLE develop significant kidney problems while others are seemingly unaffected, but genetics likely plays a role.

Some individuals do not have a previous diagnosis of SLE when they are found to have kidney problems and it is only through various blood tests that the diagnosis is made. These blood tests detect immune system abnormalities (such as ANA, antibodies directed against DNA/anti dsDNA or complement levels). Symptoms Some individuals with lupus nephritis have other symptoms related to active SLE in other parts of the body including fatigue, rash and joint pain. Some develop swelling (edema) of the eyelids in the morning and of the legs late in the day which is due to retention of fluid. Some notice foamy or bubbly urine when they urinate due to the protein in the urine. Other individuals do not have any symptoms and it may first be discovered when there is an abnormal urine test (with blood and protein) or blood test (abnormal kidney function) done by the doctor to screen for kidney problems. Some patients will have high blood pressure. Diagnosis Although abnormal blood and urine tests in an individual with SLE usually points to a diagnosis of lupus nephritis, a kidney biopsy is often performed. There are several different patterns (or classes) of kidney damage that can be seen in lupus nephritis.

This depends on which part of the glomerular filter is affected by the accumulation of autoantibodies and the degree of the damage. The names of the different patterns are: Mesangial lupus nephritis (class II) Proliferative lupus nephritis (class III and IV) Membranous lupus nephritis (class V) The only way to know (with certainty) which pattern is present is by looking at a small piece of kidney tissue under a microscope. It is important to know this information because it can influence treatment and can help determine prognosis. Your doctor will spend time talking to you about the type of pattern that you have and what that means. Sometimes, an individual with one pattern of kidney damage can develop a different pattern of injury years later. Treatment The decision to treat and the type of treatment usually depends on the results of the kidney biopsy. The result of certain blood test (such as the level of kidney function) and urine tests (such as the amount of protein or blood in the urine) may also be taken into consideration. There are several goals of treatment. Some medications are used to specifically decrease the inflammation that is actively occurring in the kidney.

Other medications are given to help alter the immune system to prevent further damage and to try to cure the disease. Steroids are usually used initially. Sometimes, this medication is given intravenously and then it may be given in pill form. Immunosuppression drugs are often used in addition to steroids. One such medication is cyclophosphamide (cytoxan) which is a chemotherapy agent. It is given intravenously sometimes once or twice a month for several months. Other medications that may be given instead of, or after cytoxan, include azathioprine, mycophenolate mofetil (MMF) and cyclosporin. These medications are routinely used in individuals who have received organ transplants. Another medication called rituximab (rituxan) is also being used in some patients. Each of these treatments have different side effects associated with them which should be discussed with the nephrologist. All can increase the risk of infections and this needs to be discussed with your physician. Physicians at the Glomerular Center are very interested in trying to determine which medications are most beneficial to treat the disease with the least side effects.

We are actively involved in nationwide clinical trials to help to figure this out and we continue to recruit individuals for these important trials. Other treatments are used to control the symptoms that can be associated with the disease. Diuretics (“water pills”) are used to help rid the body of excess salt which causes swelling (edema). Other medications are used to help control blood pressure. Sometimes a group of drugs called angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) are used for this purpose. These same medications can also help decrease the protein that is lost by the kidney. Other drugs may be used to help reduce high blood cholesterol if this is present. Prognosis The natural history of lupus nephritis varies a great deal. It depends on many different factors including the pattern of kidney injury and scarring seen on kidney biopsy. Ethnic background can also have an impact on prognosis. Black and Hispanic individuals may have a worse prognosis than Caucasians. Treatment may cure the kidney disease (remission) or at least slow the progression of the disease. Some individuals respond to therapy initially but the disease may come back.

As mentioned above, the pattern of kidney injury can change over time and the doctor may recommend further therapy or even another biopsy to detect this. Infrequently, some patients will continue to slowly lose kidney function despite treatment and may need to be on dialysis. Renal transplantation has been very successful in allowing many of these patients to lead normal lives Lupus How does Lupus affect the body? Lupus can affect many parts of the body. The most common symptoms are described below. In addition, most patients feel tired or weak. Skin Almost any type of skin rash may occur with lupus, affecting around two-thirds of patients. The characteristic lupus "butterfly" rash of the cheeks and nose is seen in about one-third of patients, while one in five patients experience mouth sores. Hives and altered skin colour (a lightening or darkening of the skin in places) can also occur. One-third of patients experience Raynaud's phenomenon, where their fingers turn white then bluish on exposure to stress, cold or vibration. Joints Joint pain (also known as arthralgia) and inflammation (arthritis) are common features of lupus.

Nine out of 10 patients experience some form of joint pain, most commonly occurring in the hands, wrists and feet. Joint pain - which is often accompanied by stiffness and/or swelling - is most severe in the morning and eases later in the day. Hair During active disease, significant hair loss, or alopecia, can occur. Usually the loss is only temporary and can be treated with a variety of remedies. Certain lupus medications, such as anti-malarial drugs and corticosteroids, may encourage hair growth. Tendons When tendons are inflamed, they can tighten, causing fingers to pull into abnormal positions such as "trigger fingers". This is, however, an unusual problem. Muscles Muscle ache, known technically as myalgia, may occur in up to two-thirds of patients. The muscles between the elbow and neck, the knee and hip are most frequently involved. Muscle inflammation or swelling is less common, but requires treatment, as unlike myalgia, it can lead to permanent muscle weakness. Lungs A thin lining called the pleura surrounds the lungs. Inflammation of this lining is called pleuritis, a condition that affects around one-half of lupus patients at some stage during their life.

This causes chest pain when deep breaths are taken. Heart Inflammation of the sac surrounding the heart, the pericardium, is called pericarditis and affects about a quarter of those with lupus. The main symptom of pericarditis is chest pain below the breastbone that is often relieved by bending forward. Kidney A condition called lupus nephritis sometimes develops when the delicate filtering mechanisms of the kidney, the nephrons, become inflamed. Blood Lupus can affect the cells of the blood system and the components of the system that are involved in blood clotting. The most common complaint is anaemia, or too few red blood cells in the bloodstream. As red blood cells carry oxygen to tissues, patients with anaemia will often feel tired. Drops in the levels of white blood cells (defenders against infection) and platelets (which help the blood to clot) are also seen in some patients. Immune System A condition known as lymphadenopathy, or swollen lymph nodes (most people know lymph nodes as "glands") can sometimes occur. Lupus patients are more susceptible to infections.

They have altered abilities to fight common infections and often take longer to recover, particularly when immunosuppressives or steroids are used. Brain and Nervous System Inflammation of the blood vessels of the brain can cause a variety of symptoms, including depression, seizures and visual disturbances. Lupus and Kidney Disease (Lupus Nephritis) - The National Kidney Foundation Lupus and Kidney Disease (Lupus Nephritis) What is lupus nephritis? There are two types of lupus. Systemic lupus erythematosus (SLE) is the form of lupus that can harm your skin, joints, kidneys and brain and may be fatal. The other form of lupus is called "discoid" lupus erythematosus, which affects only your skin. Systemic lupus erythematosus (SLE) that affects the kidneys is called lupus nephritis. Lupus is an "autoimmune" disease, meaning your immune system (your body’s defense system), which usually protects the body from disease, turns against the body. This causes harm to organs and tissues, like your kidneys.

Lupus nephritis causes inflammation (swelling or scarring) of the small blood vessels that filter wastes in your kidney (glomeruli) and sometimes the kidneys, by attacking them like they would attack a disease. What causes lupus nephritis? No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants (car fumes, factory smoke) may play a role in causing the disease. Men and women of all ages and races get lupus. However, about 90 percent of people diagnosed with lupus are women. What are the symptoms of lupus nephritis? Lupus nephritis can cause many signs and symptoms and may be different for everyone. Signs of lupus nephritis include: Blood in the urine ( hematuria ): Glomerular disease can cause your glomeruli to leak blood into your urine. Your urine may look pink or light brown from blood. Protein in the urine ( proteinuria ): Glomerular disease can cause your glomeruli to leak protein into your urine. Your urine may be foamy because of the protein.

Edema: Having extra fluid that your kidneys cannot remove that causes swelling in body parts like your legs, ankles, or around your eyes. Weight gain: due to the fluid your body is not able to get rid of. High blood pressure What tests are done to find out if I have lupus nephritis? Your doctor will do a physical examination, get your medical history, and do special tests. These tests include: Urine test to check for protein and blood Blood tests Check your levels of protein and cholesterol Check your GFR (glomerular filtration rate) to show how well your kidneys are filtering wastes Check for antiphospholipid antibodies and anti-nuclear antibodies (ANA) at least once during your disease. Kidney biopsy to look at a tiny piece of the kidney under a microscope How is lupus treated? Lupus is treated with drugs that block your body's immune system. These include drugs like steroids (corticosteroid) and antimalarial drugs. Everyone is different and your doctor will make a treatment plan that is right for you.

Usually treatment for lupus nephritis include: Corticosteroids (often called “steroids”) Diuretics Diet change Corticosteroids and immunosuppressive drugs: These medications are used to calm your immune system (your body’s defense system) and stop it from attacking your glomeruli. ACE inhibitors and ARBs: These are blood pressure medications used to reduce protein loss and control blood pressure. Diuretics: These medications help your body get rid of excess fluid and swelling. These can be used to lower your blood pressure too. Diet changes: Some diet changes may be needed, such as reducing salt (sodium) and protein in your food choices to lighten the load of wastes on the kidneys. Do these treatments have side effects? You should always speak with your doctor about the risks and benefits of any of the treatments you receive. Each of the drugs during any of these treatments can have their own side effects. Fortunately, these side effects usually are manageable for most patients. Discuss your treatment with your healthcare provider. Your overall health and the health of your kidneys should always be considered. There are times when the side effects of certain treatments are not worth the risk to your health.

If you are a woman with lupus nephritis and want to have children, you should discuss with your healthcare provider the effect your treatment may have on that process. There are ways to make sure that treatment is less harmful to this process. What is my long-term outlook? Most patients do well long-term. You may need to take drugs over many years. Even patients who have less flare-ups or symptoms should have periodic checkups. What happens if my kidneys fail? If your kidneys fail, you can be treated with dialysis or a kidney transplant. Lupus patients do as well with these treatments as people who have other types of kidney disease. Many patients with lupus nephritis have received a kidney transplant. The drugs used to prevent your body from rejecting the new kidney are the same or similar to those used to treat lupus. It is unusual for lupus to come back in the new kidney. Lupus patients with new kidneys do as well as any other patients with transplanted kidneys. Kidneys Kidneys Where are the kidneys, and what do they do? The kidneys are two bean-shaped organs that rest under your abdominal cavity, towards your lower back. Most people think of the kidneys as organs responsible for filtering blood and producing urine.

However, the kidneys play other vital roles in the body, including the regulation of blood volume, blood pH, and blood pressure. The functional unit of the kidney is called the nephron. Each nephron functions like a mini-kidney to remove waste and unneeded substances from your body, while also ensuring that you retain vital nutrients and water. How does lupus affect the kidneys? About one half of people with lupus experience kidney involvement, and the kidney has become the most extensively studied organ affected by lupus. The part of the kidney most frequently troubled by lupus is a part of the nephron called the glomerulus, a tuft of capillaries that functions to filter substances from of the blood. For this reason, the type of kidney inflammation most commonly experienced in lupus is called glomerulonephritis. Fortunately, the prognosis for patients experiencing kidney lupus is improving due to the growing number of medications that physicians have in their arsenal. What are the signs of kidney lupus? How is it diagnosed and classified?

Swelling of the ankles and abdomen may be a sign of kidney disease, but the problem with kidney lupus is that often people are not aware that it is occurring until they visit the doctor for lab tests and blood work. Testing for the disease includes urinalysis, which your doctor will check for items such as red blood cells, red blood cell casts, and protein that has leaked from your kidneys into your urine. In addition, she/he will most likely ask you to perform a 24-hour urine test and determine the efficiency with which your kidneys are filtering blood by measuring your creatinine clearance. Lastly, your doctor may also recommend you to a kidney doctor (called a nephrologist) to perform a biopsy to determine the class and degree of your kidney involvement. There are 6 levels of kidney lupus (Normal glomeruli, Mesangial disease, Focal proliferative glomerulonephritis, Diffuse proliferative glomerulonephritis, Membranous nephropathy, and Sclerosing nephropathy) and the class in which your disease falls will help your doctor to design a specific course of treatment. What is the treatment course for lupus nephritis?

The treatment of lupus nephritis is highly individualized, but several drugs provide an arsenal from which your physician may choose. Corticosteroids are often used to reduce the inflammation involved in lupus nephritis, especially milder forms. Oral prednisone can be used, as can higher doses of methylprednisolone given in “pulses.” Another class of medications called immunosuppressives can also be used. These medications help to reduce your immune system’s attack on your kidneys by suppressing certain cells involved in this response. However, both corticosteroids and immunosuppressives make you more susceptible to infection, so it is important to speak to your doctor if you feel that you are developing one. How is kidney lupus monitored? As you return to your doctor’s office, she/he will most likely keep close watch on your kidneys to ensure that your kidney involvement is not worsening. There is no all-encompassing test for kidney function; instead, your doctor will use a number of tests to monitor your blood and urine. By obtaining a blood urea nitrogen (BUN) levels and blood creatinine levels, she/he can monitor how well your kidneys are filtering blood.

In addition, you blood pressure will be monitored, since high blood pressure is an indication of kidney degeneration. High levels of protein in the urine (proteinuria) can indicate increased kidney involvement, since protein usually does not cross from your blood vessels into your kidney tubules and thus should not appear in your urine. In addition, tests of blood complement and anti-DNA antibodies can suggest inflammation that may be affecting the kidneys. An important note about medications and blood pressure Due to the silent nature of kidney lupus, it is very important that you take your medications daily as prescribed by your doctor. Even if you do not feel sick, inflammation in your kidneys and other organs can lead to permanent, irreversible scarring. Your medications can combat this inflammation right now, but permanent scarring will never go away. If kidney disease is allowed to progress without treatment, your kidneys will fail, and you will need to go to dialysis three times per week to have your blood filtered. The only way to get off dialysis is to have a kidney transplant, and organ transplant opportunities are not easy to come by. This information is not meant to frighten you, but merely to ensure that you understand how important it is to take your medications!

In addition, since the kidneys are tied intimately to the regulation of your blood pressure, it is imperative that you maintain a healthy blood pressure of 120/80 mmHg. If your doctor prescribes a blood pressure medication to keep your kidney lupus in check, be sure to take it exactly as prescribed. Limit your intake of salt to less than 3 grams per day, and try to eat a healthy, well-balanced diet. The prognosis for people with lupus nephritis does not have to be grim; it is important to remember that you play the most important role in keeping your body as healthy as possible! Sources Balow, JE, Boumpas, DT, Austin, HA. Renal Disease. In: Schur, PH, ed. The Clinical Management of Systemic Lupus Erythematosus. 2nd ed. Philadelphia: Lippincott – Raven; 1996:109-126. Dooley, MA. Clinical and Laboratory Features of Lupus Nephritis. In: Wallace, DJ, Hahn, BH, eds. Dubois’ Lupus Erythematosus. 7th ed.

Philadelphia: Lippincott Williams & Wilkins; 2007:1112-1130. Wallace, Daniel J. The Lupus Book: A Guide for Patients and Their Families. 1st ed. New York: Oxford University Press, 1995. 139-145. What Is Lupus and How Does It Affect the Body | S.L.E. Lupus Foundation What Is Lupus and How Does It Affect the Body From the 2012 Lupus Education Series Understanding what lupus is as an autoimmune disease and how it affects the body was the focus of a presentation by Dr. Laura Geraldino, MD at Columbia Presbyterian Medical Center. Dr. Robert Winchester followed her presentation with an open question and answer session. Laura Geraldino, MD – What is Lupus? Addressing the packed room, Dr. Geraldino started the night off with simple explanation of how the immune system works to lay the foundation for understanding how it malfunctions in people with lupus. An Autoimmune Disease The immune system protects the body from foreign substances and infection.

But in an autoimmune disease like lupus, the immune system attacks the body.SLE is characterized by auto-antibodies, meaning that the antibodies attack the “self” SLE is unpredictable, varying in how it affects every person. It cannot be cured but controlled Illnesses occur when the body tissues are attacked by its own immune system. Manifestations of Lupus The American College of Rheumatology provides the following criteria for diagnosing lupus: Malar rash — the classic butterfly rash on the face crossing the nose and cheeks that can be very subtle or very noticeable Discoid rash — round lumps on the skin that appear most often on the scalp and ears Oral lesions — sores in the mouth, often on the roof of the mouth Arthritis — joint pain, mostly in the hands and knees Serositis — inflammation around the lungs, heart and abdomen Lupus Pleuritis — chest pain with breathing, fluid around the lungs Lupus Nephritis — kidney disease varies widely from person to person; biopsy is used to determine the type and extent of damage Lupus in the Nervous System — varies widely, affecting the brain and nervous system. Nineteen related physical and emotion syndromes include anxiety, headaches, seizures and memory loss.

Positive ANA — Blood test used to screen for lupus. Almost everyone who has lupus will have a positive ANA test, but not everyone who has a positive ANA test has lupus. Other Manifestations Fatigue — very common and can be very debilitating Fever — can be caused by lupus or by something unrelated so needs to be checked by doctor Hair loss — can be thinning hair or patches Purple fingers in the cold — painful Blood clots Consequences People with lupus are at greater risk for health issues and death, making early diagnosis and close monitoring essential! However, the outlook is much more positive for people with lupus than it was 50 years ago. Bio: Laura Geraldino Pardilla, MD Dr. Geraldino specializes in autoimmune diseases, especially Systemic Lupus Erythematosus (Lupus) and Rheumatoid Arthritis. She heads up the Lupus Clinic at Columbia University Medical Center. Working in this predominantly Hispanic neighborhood made her notice and develop an interest for lupus as an autoimmune disease with increased frequency and severity in this ethnic group. Having completed her residency in Internal Medicine at State University of New York Upstate Medical University, Syracuse, NY, Dr.

Geraldino went on to complete a second fellowship in musculoskeletal ultrasound at USSONAR Cooper Health System. Robert Winchester, MD – Who Gets Lupus and Why? Dr. Winchester’s approach was quite different – instead of giving a presentation, he asked the audience for questions relating to who gets lupus and why it develops. Following is a sampling of the very lively Q&A “conversation” between Dr. Winchester and attendees. How is lupus a genetic disease? It is not inherited in a simple fashion, like for example eye color, but is the result of at least 40-50 genes each of which contribute a part of the risk for lupus. However, these are not abnormal genes in the sense that the gene for sickle cell disease makes an abnormal hemoglobin in the red cell. Each gene independently appears to be beneficial, perhaps contributing to a stronger and more vigorous immune response. However it looks that when we inherit too many of these genes they “gang up” and result in the abnormal immune response that results in lupus. Our knowledge of these genes comes from the Human Genome Project, where scientists have sequenced DNA, which led to the identification of all of the different genes.

Research work supported by the Lupus Research Institute has helped help show that these genes are important to developing lupus and that they work in some part of the immune system work; some may help in some circumstances but have a harmful effect in others. We are going towards personalized medicine which would allow us to identify specific genes that predict risk for lupus for some people. How do you differentiate among all the autoimmune diseases to determine that a person has lupus? Good question as there are over 100 autoimmune diseases and many of the symptoms overlap. But we look for a pattern of symptoms that indicate the processes going on. For instance, Sjogren’s and lupus have many similar clinical and laboratory features such as a positive ANA, but Sjogren’s symptoms typically affect the eyes and the ability to swallow dry crackers because of the lack of saliva, while lupus does not. So when a patient describes those symptoms, we can begin to hone in on where in the body the disease is targeting that indicate which type of autoimmune disease may be responsible. How does lupus develop? Lupus does not just happen over a few hours or days.

Recent research work shows years before you develop the symptoms of lupus, those autoantibodies were already there in your body and were attacking your “self” just a little so you still felt perfectly healthy. This is considered a pre-clinical, pre-lupus state and it may offer a window of time before the disease symptoms starts when we may be able to intervene to change the course of this autoimmune response and block development of the clinical disease. We are just learning about this and about the genes that are responsible, but with the groundbreaking research going on now, within five years, we may be able to modify or nullify the genes that can cause lupus. We hope we can put the genie back in the bottle to maintain or revert back to this pre-lupus state. Even now, if there is a strong family history of lupus, we might consider starting a person who is found to have a positive ANA and other certain autoantibodies on an anti-malarial drug like hydroxychloroquine to try to prevent the clinical disease of lupus from developing.

Also, if we know a person as a family history so may be predisposed to lupus, we would recommend ways to reduce their risk by cutting down on lifestyle factors known to trigger lupus such as avoiding direct sunlight and not smoking. Why don’t we hear much about research in lupus? As you know, lupus is an extremely difficult and challenging disease. There has always been research going on, but now there is an explosion of research in the field and we expect revolutionary changes in how the disease is diagnosed and treated within about five years. And since lupus is an autoimmune disease among at least 100 others, advances in one disease like type-1 diabetes can be an advance in another autoimmune disease like lupus. So some research that was not initially targeted to lupus in fact produces knowledge that advances our understanding of lupus. Is lupus caused by genetics or environment? Both. It is genetic in the sense that you always had the predisposition to make the antibodies that cause lupus. But these predisposing genes are influenced by environmental events, such that an infection or smoking can bring it out. Does nutrition have any impact on lupus? There is no evidence that food impacts lupus.

However, there is research looking at whether chemical additives in foods could have a negative effect. Also studies have indicated that below normal levels of Vitamin D may raise the risk for lupus while taking the vitamin might reduce the severity of the disease. Research has also suggested that small amounts of alcohol might be beneficial, perhaps to relax the body and alleviate stress. But not too much! Does vaccination impact lupus? There is no clear answer yet. But research has indicated that there is no relationship between immunization and a greater likelihood of developing lupus or a greater risk for developing a flare. In fact, immunizations like the flu or pneumococcal vaccine are generally recommended for people with lupus because you are immunodeficient. In lupus, immunodeficient or immunocompromised means that while the lupus is causing your body’s antibodies to attack your own body they are distracted from attacking the invader such as the flu virus. Vaccination can stimulate your body’s immune system in a positive way to create antibodies that will attack the virus specifically. Bio: Robert Winchester, MD Dr. Winchester is a Professor of Pediatrics, Pathology, and Medicine at Columbia University and has spent his career studying the autoimmune diseases and the genetic basis of those who develop them.

He identified various allelic forms of HLA-DR, and was the first to show that the genetic susceptibility to systemic lupus differed from that associated with rheumatoid arthritis. Many of Dr. Winchester’s discoveries in the genetic factors influencing lupus have been made possible by grants from the Lupus Research Institute

Question: Which organ of the body is affected by nephritis ?
Answer: THE KIDNEYS