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Lupus nephritis

  

 

  An Update On Lupus Nephritis

  Lupus is a chronic autoimmune disease that can affect a variety of different body parts. These include the kidneys, brain, lungs, heart, joints, skin and blood. Under normal circumstances the body has an internal immune surveillance system which recognizes and protects the body from bacteria, viruses and other foreign substances. In the face of these foreign substances, the body activates cells and makes proteins called antibodies to attack and clear these foreign substances. Autoimmune disorders like lupus prevent the body from recognizing the difference between itself and these foreign substances. The result is the body makes antibodies to itself which cause the inflammation associated with lupus.

  The cause of lupus is unclear and likely involves genetic and environmental interactions. Interestingly, people of Hispanic, Asian, Native Indian and African American descent are more commonly affected than those of Caucasian descent. There are 11 criteria utilized to diagnose lupus including; blood-work results, neurological disorder, kidney disorder, arthritis, skin rashes, oral ulcers or photosensitivity. In order to apply the diagnosis, a patient must possess at least four of these. Lupus severity is patient specific and can range from mild, involving a few organs to life threatening. Lupus can be cyclical involving periods of “flares” in which the patient is symptomatic to states of remission when the disease appears to be quiet.

  Kidney involvement is one of the most worrisome and potentially serious complications of lupus. Kidney inflammation in the setting of lupus is referred to as lupus nephritis. Over 60 percent of children with lupus will develop lupus nephritis requiring medical intervention. Once identified, a rapid kidney biopsy is essential to begin appropriate treatment and prevent the development of chronic renal failure. On rare occasions lupus nephritis may occur as the solitary symptom of lupus. These children do not meet the criteria for systemic lupus but their kidney disease can fit the classic pattern of lupus nephritis. Kidney involvement may come in a variety of forms. Essentially these all involve some degree of inflammation and have been categorized.

  How Does Pediatric Lupus Nephritis Present?

  The presentation of childhood lupus nephritis can be quite variable, often few signs or symptoms exist. Children and adolescents may present with weight gain and swelling of the legs, ankles or feet (edema) that is absent in the morning but progressively gets worse throughout the day. This is the result of excessive loss of protein in the urine due to damage to the filters of the kidneys. In this setting the patient may complain that his/her urine is quite foamy and they may have to get up at night to urinate or have night time bed wetting. Children and adolescents may also have headaches/visual changes due to the development of high blood pressure. High blood pressure can be quite severe when associated with lupus nephritis reflecting damage to the kidneys and/or fluid retention. Lupus nephritis is usually not associated with pain in the back or abdomen. Diagnosis is often suggested by laboratory examination and confirmation usually requires a kidney biopsy.

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