Lupus and the kidneyLupus and the kidney

Suzanne El-Sayegh, MDSuzanne El-Sayegh, MDAssociate Chairman of MedicineAssociate Chairman of Medicine

Director of Nephrology Director of Nephrology Staten Island University HospitalStaten Island University Hospital

Lupus and the kidneyLupus and the kidney

• SLE is a systemic diseaseSLE is a systemic disease• Affects all organsAffects all organs• Kidney disease is common Kidney disease is common

– Can affect up to 50% of patientsCan affect up to 50% of patients– Kidneys have high blood flow: high Kidneys have high blood flow: high

exposure to preformed antibodiesexposure to preformed antibodies– Male patients, certain ethnic group are Male patients, certain ethnic group are

more at riskmore at risk

Lupus and kidney diseaseLupus and kidney disease

• Called also lupus nephritisCalled also lupus nephritis– Inflammation of kidneysInflammation of kidneys– Can be treated with medications with Can be treated with medications with

resolutionresolution– Or can lead to scarring and fibrosisOr can lead to scarring and fibrosis

Manifestation of diseaseManifestation of disease

– Could be silentCould be silent– Blood in the urine ( that the patient can Blood in the urine ( that the patient can

not see)not see)– Protein in the urine ( foamy urine)Protein in the urine ( foamy urine)– High blood pressureHigh blood pressure– EdemaEdema– Renal failure Renal failure

• Since disease could be silent:Since disease could be silent:– All patients need follow/up with their All patients need follow/up with their

physician to check BP and to examine physician to check BP and to examine the urine for blood and proteinthe urine for blood and protein

Lab testsLab tests

• In order to know if lupus is active in In order to know if lupus is active in the kidneys we can order some blood the kidneys we can order some blood tests:tests:– Anti DNA will be elevatedAnti DNA will be elevated– Complement level ( c3, c4, ) might be Complement level ( c3, c4, ) might be

lowlow– ESR could be highESR could be high– Urinalysis: blood , protein , RBC catsUrinalysis: blood , protein , RBC cats

Kidney biopsyKidney biopsy

• Always indicated: why?Always indicated: why?

– Define the stagingDefine the staging– Determine the therapyDetermine the therapy– Assess prognosisAssess prognosis– Assess chance of recoveryAssess chance of recovery

TreatmentTreatment

• Therapy is divided into standard therapy Therapy is divided into standard therapy and specific therapy to target the lupus in and specific therapy to target the lupus in the kidneys:the kidneys:– Standard therapy:Standard therapy:

• Control blood pressureControl blood pressure

• Control protein in the urine: use angiotensin Control protein in the urine: use angiotensin converting enzyme drugs, or angiotensin receptor converting enzyme drugs, or angiotensin receptor blockersblockers

• Might need to use diuretics ( water pills)Might need to use diuretics ( water pills)

• Might need to use medication to lower cholesterol Might need to use medication to lower cholesterol specially in patients with heavy proteinuriaspecially in patients with heavy proteinuria

• Targeted therapy:Targeted therapy:– Depends on the result of kidney biopsyDepends on the result of kidney biopsy– Include: induction phase and Include: induction phase and

maintenance phasemaintenance phase– Medications used: cyclophosphamide, Medications used: cyclophosphamide,

mycophenolate mofetil, azathioprine, mycophenolate mofetil, azathioprine, rituximabrituximab

• Prognosis depends on the kidney findingsPrognosis depends on the kidney findings• If no response and renal function continues If no response and renal function continues

to deteriorate patient will require dialysisto deteriorate patient will require dialysis• Kidney transplant is an optionKidney transplant is an option• Pregnancy is not contraindicated howeverPregnancy is not contraindicated however

– patients should be stable on low dose of patients should be stable on low dose of prednisone,prednisone,

– lupus should not be active,lupus should not be active,– minimal protein in the urine minimal protein in the urine – and good kidney functionand good kidney function