SYSTEMIC LUPUS

The “classic” autoimmune disease

Statistics

Females are more at risk then males

Ratio of female to male risk is 10:1

Anyone can be affected

Many Organ Systems InvolvedSkinJointsNervous systemLungBloodKidney*Heart

The Kidney

Filters bloodExcretes wasteManages body chemicals - Sodium (salt), Potassium, Calcium

Manages acid state of bodyBlood PressureKeeps protein from leaking out

The Kidney

The kidney has high blood flow rates, prone to immune damage

This will cause inflammation and possibly scarring

Kidney Involvement When:

Body swellingHigh blood pressureBlood in urineAbnormal body chemistry--too much acid, too much water, abnormal potassium, etc.

Foamy urineDecreased kidney function

Both Kidneys Always InvolvedFillers (Glomeruli) and support structures are involved

Therefore called Glomerulonephritis

Recurrent urinary tract infections can be misdiagnosed as urinary infection when really inflammation

Will manifest with blood in urine (hematuria), and/or protein in urine (proteinuria)

If more then 3.5g of protein in 24hrs, we call this Nephrotic Syndrome

Blood proteins can drop, cholesterol and blood pressure can rise, and the kidney can scar

Best Way To Access:

Urine examKidney function: CreatinineCholesterolProtein levelsBlood pressureMarkers of inflammation

Markers of inflammation or immune function:

ANA double strand DNAC3C4ESRCRP

Kidney biopsy is the best way to diagnosisand determine treatment of Lupus Nephritis.

It tells the degree of inflammation and scarring present.

WHO Classifications - biopsy

I

Normal

II

Mesangial

III

Focal Proliferative

IV

Diffuse Proliferative

V

Memberanous

VI

Scarred

If no scarring, then treat all:InflammationHigh Blood PressureSalt RetentionHigh Cholesterol

These treatments have been worked out by enrolling patients into well designed studies, where they have been treated ethically and with the utmost care.

Control blood pressure to normal level 120/80

Use ACE inhibitor and/or ARBThese also decrease protein leakage

PROTEIN SPILLAGE CAUSES KIDNEY SCARRING!!!

Lower cholesterol with statins

Get rid of salt and lower blood pressure with diuretics

We usually use all of these methods in concert

Decreasing inflammation will decrease scarring

Cortisone-Prednisone is base of regimen

Cyclophosphamide very critical - worked out through large studies at NIH

Treatments

Azathioprine-weakerMycophenalate- “Cellcept”CyclosporinePrografRituxiumab

Treat Before Scarring

Once scarring occurs, cannot reverse injury

One should not prophylactically treat patients without kidney disease who have lupus

By lowering blood pressure, cholesterol, etc., scarring can be decreased and non renal complications lessened.

How to Determine Which Medication to Administer

Use studies that compare and contrast

Determine if one treatment is better for a certain group of patients

Get involved with trials

YOU ARE NOT A GUINEA PIG!!!

Lupus has become a very treatable disease. Only good studies can make it more treatable.

THANK YOU

Remember, being involved in good studies will help lupus therapy for you and

everyone.