Lupus

Systemic lupus erythematosus is the classic “autoimmune disease”. The cause is still unknown but 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, attempting rejection.The immune system is stimulated, which reacts against many body parts 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 otherwise, serious deterioration.

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, and bruise easily due to low platelet counts (clotting factors). Patients can present with joint inflammation which may look like rheumatoid arthritis or chest pain, which can masquerade as a heart attack. As in so many diseases, having a high index of suspicion leads to getting the right blood tests to rule out or confirm a lupus diagnosis.

Lupus often requires physicians from different specialties to be involved; nephrologists need to carefully follow the kidney involvement. Sometimes early intervention prevents lupus kidney disease from advancing. On the other hand, patients who have received kidney transplants are doing generally well.

Prednisone is one of the medications used to treat lupus.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. Another drug used more for  skin and joint involvement, is 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 FDA-approved. This was the first new FDA-approved lupus drug 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 medical practitioners to manage lupus with a lower level of prednisone.