Systemic lupus erythematosus is the classic autoimmune disease. The cause is still unknown. Genetic factors play a significant role. For reasons not yet understood, the immune system in lupus patients perceives some of the body as being foreign and attempts to reject it. The immune system is stimulated which reacts against many parts of the body including the lining of joints, heart and lungs. Skin is often involved as well as parts of the central nervous system. Kidney involvement can be severe but fortunately strong medications are available to help prevent serious deterioration which would otherwise happen.
Anyone can be affected with lupus although it is typically more common in African American women of childbearing age. The presentation can be mysterious as lupus can involve so many different parts of the body. Patients may have unexplained fevers or rashes. They may have easy bruising with low platelet counts (clotting factors). They can have joint inflammation which may look like rheumatoid arthritis or chest pain which could masquerade as a heart attack. As in so many diseases, having a high index of suspicion leads to getting the right blood tests and considering lupus as a possibility.
Lupus often requires physicians from different specialties to be involved. Nephrologists need to be following the kidney involvement. Sometimes early intervention prevents lupus kidney disease from advancing. On the other hand, we have patients who have received kidney transplants and are doing generally well.
Medications used for lupus include prednisone. This drug is a double-edged sword as it can be lifesaving but at the same time can cause significant side effects including weight gain, diabetes, and compression fractures. Other drugs used more for skin and joint involvement include Plaquenil. For severe kidney involvement, drugs such as CellCept and Cytoxan can be quite helpful. In the last few years, a new intravenous drug ,Benlysta , was approved by the FDA. This was the first new drug approved for lupus in 50 years and appears to be more helpful in the non-kidney aspects of lupus. The intention is that all these drugs may allow us to get away with a lower level of prednisone.