Lupus nephritis is a common condition that affects the kidneys of up to 50 percent of people living with lupus. Lupus (also called systemic lupus erythematosus, or SLE) is an autoimmune disease that involves the immune system attacking many organs and tissues in the body. A person living with lupus develops lupus nephritis when their kidneys become damaged by the immune system and begin to decline in function. Treatment for lupus nephritis focuses on preventing the progression of kidney disease and improving the symptoms associated with the condition.
Goals for the treatment of nephritis include preventing further kidney damage and treating the symptoms associated with the decline in kidney function. The main goal is to slow or stop the disease’s progression and the eventual need for dialysis or a kidney transplant. Lupus nephritis treatment usually involves suppressing the immune system to limit damage to the kidney. Many of the therapies used for lupus nephritis are also used to treat lupus in general.
Lupus nephritis impairs important kidney functions including filtering waste and excess fluid out of the blood and into the urine and regulating blood pressure. Lupus nephritis signs and symptoms that require treatment include:
Treatment approaches vary for people with lupus nephritis depending on the stage of the disease. There are six stages of lupus nephritis, which progress in severity based on the amount of kidney damage and how well the kidneys are functioning. A doctor will run tests on the blood and urine, and they may collect a kidney biopsy to determine the stage of lupus nephritis. People diagnosed with the later stages of lupus nephritis will require more intensive therapy.
Check out five types of treatment that can help you manage lupus nephritis.
Immunosuppressants are medications used to suppress inflammation and overactivity of the immune system. During lupus nephritis, inflammation caused by the immune system can damage the kidneys. Immune cells can also attack the kidneys.
Immunosuppressive drugs affect the immune system’s ability to fight off infection. As a result, a person using immunosuppressants to treat lupus nephritis should take precautions to avoid people who are sick or have an active infection.
There are several classes of immunosuppressant medications used to treat lupus nephritis.
Corticosteroids — sometimes referred to as glucocorticoids or steroids — are artificial hormones that are similar to the hormone cortisol, which the body produces naturally. Steroids work by reducing the production of molecules that cause inflammation and suppressing the activity of cells in the immune system. Some common examples of steroids include prednisone, cortisone, and methylprednisolone. These drugs can be taken orally (by mouth) or through injection.
Although steroids can effectively reduce inflammation and immune system activity, some serious side effects are associated with their long-term use. These include high blood pressure, high blood sugar, and osteoporosis (weakening of the bones). A doctor may want to limit the amount of time a person uses steroids.
Some chemotherapy drugs can be used as immunosuppressants to treat lupus nephritis. Chemotherapy drugs prevent the growth and division of cells, including the cells in the immune system that divide when they are activated. This activation and cell division occurs during autoimmune disease and can lead to an attack on the body’s tissues — including the kidneys. Some common examples of chemotherapy drugs used to treat lupus nephritis include cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept).
Each type of chemotherapy drug will have side effects. Common side effects include nausea, upset stomach, and fatigue.
Calcineurin inhibitors work by inhibiting (holding back) calcineurin, an enzyme inside immune cells. Inhibiting calcineurin can prevent immune cells from attacking the body’s own tissues. Common calcineurin inhibitors used for the treatment of lupus nephritis include voclosporin (Lupkynis), cyclosporine, and tacrolimus.
Calcineurin inhibitors must be used carefully during the treatment of lupus nephritis, as they can harm the kidneys and liver. High blood pressure is another side effect associated with these medications.
Biologic treatments are designed to bind to various inflammatory molecules and cell types associated with lupus nephritis. They are given by injection instead of by mouth to prevent the digestive system from breaking them down or not absorbing them. After being injected, the biologic can destroy or block its target in the body. The only biologic approved to treat lupus nephritis is belimumab (Benlysta), but in some cases, doctors may prescribe rituximab (Rituxan) as an off-label treatment for lupus.
Common side effects of biologic therapies include:
The kidneys are involved in regulating blood pressure. Both kidney damage and medications such as oral steroids can cause high blood pressure for people with lupus nephritis. Unfortunately, high blood pressure can further damage the kidneys, making it important to control high blood pressure during the treatment of lupus nephritis. Controlling blood pressure can also prevent proteinuria, which occurs when extra protein leaks into the blood, causing foamy urine.
Common blood pressure medications used to treat lupus nephritis symptoms include ACE inhibitors and angiotensin-receptor blockers.
The kidneys remove excess fluid from the body. The kidney damage that occurs during lupus nephritis can affect this function. Diuretics are medications that remove fluid from the body. They can also help reduce blood pressure. Commonly used diuretics for the treatment of lupus nephritis include furosemide (Lasix) and hydrochlorothiazide (abbreviated as HCTZ).
People diagnosed with stage 6 lupus nephritis usually need more intensive therapy. Stage 6 lupus nephritis is diagnosed when 90 percent or more of the kidney has been damaged, and kidney function is very poor. Treatment for stage 6 lupus nephritis must replace the function of the kidneys. One option for this stage is dialysis.
Dialysis is a medical procedure that removes waste and certain chemicals from the blood. Healthy kidneys can do this for the body, but once a person loses kidney function, they must rely on dialysis to clean the blood.
There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, the blood is extracted and cleaned with a dialysis machine. In peritoneal dialysis, waste is drawn out of the body by putting dialysis fluid in the abdomen.
Both types of dialysis clean the blood by removing waste, salt, and excess water from the body. Dialysis also ensures the levels of potassium, bicarbonate, and sodium in the blood are balanced. This procedure can also help control blood pressure.
Dialysis must be performed often and can be time-consuming. For example, hemodialysis can take up to four hours and is typically performed three times per week.
An alternative to dialysis is receiving a kidney transplant. A kidney transplant can restore kidney function. Getting a transplant first requires:
Finding a donor may be a challenge because the two individuals must have certain matching characteristics to make it less likely that the body will reject the transplant.
After the transplant operation, the recipient will have to take antirejection medications to prevent the body from attacking the transplanted kidney.
The recurrence of lupus nephritis in the new kidney is possible, and some people living with the condition may end up needing a second kidney transplant.
Living a healthy lifestyle can support kidney health and help in the management of lupus nephritis, so you can try to prevent severe lupus nephritis or kidney failure. Habits that support overall and kidney health include:
Make sure to see a nephrologist (kidney specialist) along with your rheumatologist if you have active lupus nephritis so you can work together to create a treatment plan to help you manage the condition.
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