Lupus Nephritis Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Lupus nephritis is one of the most serious manifestations or complications of lupus ( Systemic Lupus Erythematosus ). Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by inflammation that spreads to various human organs.
The prevalence of SLE varies between countries, between 2.9/100,000–400/100,000. While cases of lupus nephritis, found in 40-75% of patients with SLE. Kidney disorders generally occur after 5 years of suffering from SLE.
Lupus nephritis occurs because the body’s immune system, which should be fighting germs, instead attacks cells and tissues in the kidneys, causing damage to this organ. In its early stages, lupus nephritis will cause the filtering ability (filtration) of the kidneys to decrease. As a result, protein will be excreted through the urine in large quantities. This condition will cause the body to lack protein and trigger swelling of the limbs and face.
Lupus disease must be treated and controlled properly. If left unchecked, lupus nephritis will continue to damage the kidneys and can cause kidney failure. As a result, sufferers have to do dialysis or kidney transplant.
Symptom
In the early stages of lupus nephritis, sufferers may not show any symptoms. In severe kidney disorders, swelling will appear in parts of the body, due to protein leakage in the urine.
The various symptoms of lupus nephritis are:
- presence of blood in the urine
- high blood pressure
- swelling of the body
Reason
Lupus nephritis occurs because the body’s immune system attacks cells and tissues in the kidneys. The kidney is one of the organs that is attacked in SLE. Immune complex deposits will precipitate in the glomerulus and cause inflammation of the kidney glomerulus.
Meanwhile, the cause of SLE itself is not known with certainty. However, this condition is thought to involve a complex and multifactorial interaction between genetic variation and environmental factors. There is a lot of evidence that the pathogenesis of SLE is multifactorial such as genetic factors, environmental factors, and hormonal factors on the immune response.
Diagnosis
The diagnosis of lupus nephritis can be determined by doing the following:
- Medical interview and physical examination. During the medical interview, a history of SLE and complaints such as difficulty urinating or swelling of the body can be traced. Identification of various other systemic symptoms in SLE is also needed such as the presence of a reddish rash on the face, joint pain or hair loss.
- Urine examination. The diagnosis of lupus nephritis can be established if there are signs of proteinuria in the amount of more or equal to 1 gram/24 hours or/with hematuria (> 8 red cells/large field of view) or/with decreased kidney function up to 30%.
- Kidney biopsy. The definitive diagnosis of lupus nephritis is determined from a kidney biopsy. Based on the biopsy findings and the characteristics of the patient’s urine examination, lupus nephritis can be divided into six different types.
The different classes of lupus nephritis are:
- Class I – Minimum mesangial lupus nephritis.
- Class II – Lupus proliferative mesangial nephritis.
- Class III – Focal lupus nephritis.
- Class IV – Diffuse lupus nephritis.
- Class V – Lupus membranous nephritis.
- Class VI – Severe sclerosing lupus nephritis
Treatment
Treatment of lupus nephritis depends on the severity of the disease. In cases of inactive lupus nephritis (grades 1, 2, 5 and 6), treatment is usually based on manifestations in other organs.
Whereas in active kidney lesions, therapy in the form of giving an immune system suppressor can be given. Some of the drug choices that are often used are chloroquine, cyclophosphamide and steroids. In severe renal impairment, renal replacement therapy such as hemodialysis is required.
Prevention
There is no definite prevention for the occurrence of lupus nephritis. However, improvement of kidney function and prevention of worsening of kidney function are the treatment targets of lupus nephritis. Routine control and use of appropriate drugs is one way to prevent the worsening of kidney function in cases of lupus nephritis.