New Guidelines for Kidney Disease Due to Lupus
Early Diagnosis, Aggressive Treatment Changing the Playing Field for Lupus Kidney Disease
May 3, 2012 -- When lupus attacks the kidneys, the damage can be life-threatening. Now, updated guidelines from the American College of Rheumatology are aimed at identifying kidney involvement in lupus early and treating it aggressively to stop this damage in its tracks.
Systemic lupus erythematosus (SLE), or lupus, is an autoimmune disease that occurs when the body's immune system mistakenly attacks its own tissues. Some symptoms include rashes, joint pain, and fatigue.
About 1.5 million Americans have lupus, and one-third of them will develop kidney involvement, or lupus nephritis, as a result, according to the Lupus Foundation of America. Most at risk for lupus nephritis are African-Americans under the age of 25 and children with lupus. African-American men are considered high risk. Just recently actor and rapper Nick Cannon, husband of Mariah Carey, told various media outlets that he has lupus nephritis.
It is often silent, but lupus nephritis symptoms may include:
- Weight gain
- High blood pressure
- Dark urine
- Swelling around eyes, legs, ankles, or fingers
New Guidelines Focus on Early Diagnosis of Lupus Nephritis
Guideline co-author Bevra Hahn, MD, a professor of medicine at the University of California, Los Angeles, and colleagues reviewed the literature for studies on lupus kidney disease to come up with a plan on how to better diagnose and manage this condition. Last updated in 1999, the new guidelines appear in Arthritis Care and Research.
According to the guidelines, a kidney biopsy is a consideration in all people with lupus who show signs of active kidney involvement.
"With earlier diagnosis and treatment, we really minimize the damage caused by lupus nephritis," says Joan T. Merrill, MD. She is the medical director of the Lupus Foundation of America and one of the authors of the new set of guidelines.
This is important as early kidney involvement is often silent, says Merrill. "Doctors should be watching the urine and seeing if there is any evidence of kidney disease. Theoretically, we should be able to pick up kidney involvement before it gets symptomatic." Merrill is also a professor of medicine at the University of Oklahoma Health Sciences Center in Oklahoma City.
Biopsy is the best way to identify kidney disease early, says Sandra C. Raymond, the president and CEO of the Lupus Foundation of America in Washington D.C. "It is the quintessential diagnosis tool for lupus nephritis. They can tell whether it is lupus or not that is causing the symptoms."
The guidelines also state that people with lupus nephritis may benefit from "background treatment" with the anti-malarial drug hydroxychloroquine to prevent damage to the kidney and elsewhere in the body.
Blood pressure and cholesterol control is also key. "Blood pressure should never be higher than 130/80," Hahn says. Some blood pressure medications known as ACE inhibitors and ARBs may also protect the kidney.