Lupus-nephritis: diagnosis, treatment, diet

Lupus nephritis is one of the most common complications of systemic lupus erythematosus. SLE is an autoimmune disease caused by the appearance in the body of antibodies that perceive "native" proteins as foreign. As a result, aseptic inflammation develops in different parts of the body. Including in the kidneys.

Definition

Lupus nephritis, or lupus nephritis - is a serious kidney disease in systemic lupus erythematosus. The prevalence of this disease in the population is on average forty people per one hundred thousand of the population. Most often, representatives of the beautiful half between the ages of twenty and forty are ill. Most pathology is found in the Afro-Caribbean population.

The disease can be caused by a variety of factors: from excessive tanning, to genetic disorders, so it is extremely important to pay attention to symptoms in time and go to the doctor. After all, the earlier treatment is started, the better the prognosis for the life and health of the patient.

Etiology

Lupus nephritis can be triggered by permanent long-term insolation (infatuation with a solarium or living in sunny places), allergy to medicines, permanent stress and even pregnancy (the fetus is perceived as an alien organism and the immune system begins to attack the mother's cells).

In addition, genetic predispositions, the presence of hormonal imbalance, frequent viral diseases (viruses are built into the body cells, leaving their antigens on their surface and thereby provoking an immune response) influence the development of the disease. The chance of developing the disease in close relatives is several times higher than the average for the population.

Pathogenesis

Lupus nephritis is part of a large symptom complex developing with systemic lupus erythematosus. Autoantibodies primarily develop to native DNA and its connection with histones, to complement system proteins and cardiolipin. The reason for such aggression is a decrease in tolerance to its own antigens, defects in B and T-lymphocytes.

The development of jade is directly related to the fact that antigen-antibody complexes are tropic to the tissues of the renal tubules. Once such a protein molecule is attached to the cell surface, it triggers a cascade of biochemical reactions that release active substances that melt the cells. This, in turn, causes an inflammatory reaction, which only aggravates the destruction.

Pathomorphology

Lupus-nephritis in SLE can have different morphological manifestations. When patients are opened, changes in the glomeruli of the glomeruli of the kidneys, active division of their cells, expansion of mesangium, sclerosis of vascular loops and others are noted. These manifestations can be both in one and in several glomeruli.

The most specific for lupus nephritis is fibrinoid necrosis of the capillaries of the Henle loop, as well as the histologically detected karyopicnosis and karyorexis (division and lysis of the cell nucleus). In addition, pathognomonic changes in the basal membranes of the glomeruli in the form of "wire loops" and the presence of hyaline thrombi in the lumen of the capillaries as a result of the deposition of immune complexes.

Classification

Clinically and morphologically, several stages can be distinguished that go through lupus-nephritis. The classification of the World Health Organization looks like this:

1. First class: the glomeruli have a normal structure.
2. Second class: there are only changes in mesangium.
3. Third class: glomerulonephritis with a lesion of half of all glomeruli.
4. Fourth class: diffuse glomerulonephritis.
5. The fifth class: membranous glomerulonephritis.
6. Sixth grade: sclerosing glomerulonephritis.

There is also the classification of Serov, in which he distinguishes focal, diffuse, membranous, mesangioproliferative, mesangiocapillary and fibroplastic glomerulonephritis.

Symptoms

Membranous lupus-nephritis has both obligate and facultative symptoms. One of its mandatory manifestations is proteinuria, that is, the presence of protein in the urine. It is also often possible to find hematuria, leuko - and lymphocyturia. These signs indicate the presence of an inflammatory process in the kidneys and can be not only with SLE.

With the progression of the autoimmune process, the symptoms of renal failure increase , manifested by an increase in the level of creatinine in the blood and urine, weakness, sluggishness of the patient, co-morbid conditions.

There is a slow progressive and rapidly progressive nephritis. If the disease develops slowly, then the urinary and nephrotic syndrome prevail . In addition, lupus nephritis can take place in an inactive or latent form, when only minor proteinuria is present from all the symptoms.

Rapidly progressing lupus jade is very similar to classical glomerulonephritis. Renal insufficiency is rapidly growing, there is a macrohematuria, increased blood pressure and nephrotic syndrome. In severe cases, the syndrome of disseminated intravascular coagulation (DVS) can develop .

Lupus nephritis in children

In 1/5 of all patients with systemic lupus erythematosus, the first symptoms of the disease appeared in childhood. In children under 10 years of age, it practically does not occur, but there is a description of cases of SLE in a child of one and a half months old.

The development of the disease in children does not differ from that in adults. The clinical picture can be diverse: from asymptomatic to rapidly progressive. Acute renal failure is rare.

There are several signs of SLE in a child:

• Erythema on the face;
• Discoid rashes on the body;
• Sensitivity to sunlight;
• Ulcers on mucous membranes;
• Inflammation of the joints;
• Kidney damage;
• Violation of the central nervous system;
• Increased bleeding;
• Immunological disorders;
• Presence of antinuclear antibodies.

If the clinic has at least four signs from this list, then you can confidently state that the child has systemic lupus erythematosus. Kidney failure in childhood rarely comes to the fore. Typically, symptoms can range from glomerulonephritis to manifestations of antiphospholipid syndrome.

The prognosis of the development of the disease in children is more favorable. Ten years after the diagnosis, dialysis is required for only 10 percent of patients.

Diagnostics

What gives the doctor an excuse to suspect lupus nephritis? Diagnostics, as a rule, relies on already available clinical and laboratory confirmed data on SLE:

• Pain and inflammation in the joints;
• Rashes on the face skin in the form of a butterfly;
• Presence in the anamnesis of effusion in the cavity (pleurisy, pericarditis);
• Rapid loss of body weight, fever.

In the general analysis of blood anemia, a decrease in platelets, an increase in the rate of erythrocyte sedimentation, a decrease in complement proteins is observed. For diagnostics, it is important to identify antibodies to native DNA.

As a rule, this is enough to diagnose systemic lupus erythematosus and, as a consequence, lupus nephritis. However, the appearance of protein in the urine may be delayed by one to two years from the manifestation of the disease. In this case, the physician relies on enzyme immunoassay and antibody detection. If there is no confirmed laboratory data, then it is necessary to continue the diagnostic search, especially for male patients, since for them the given nosology is quite rare.

Differentiate lupus nephritis with SLE with bacterial endocarditis, exacerbations of rheumatoid arthritis, myeloma, chronic hepatitis, amyloidosis, and Shenlaine-Henoch syndrome.

The first stage of treatment

Treatment of lupus nephritis is a long and painstaking process, which often lasts the rest of your life. It takes place in two stages. At the first stage, the exacerbation of the disease is arrested. The goal of treatment is to achieve a stable remission, or at least reduce clinical manifestations.

Reception of medicines should begin as soon as possible from the moment of statement of the diagnosis. Everything happens so quickly that even a delay of five to seven days can be a fatal mistake. If the activity of the process is low (this will show the antibody titres), the doctor may limit the appointment of corticosteroids in high doses for a period of two months, followed by a slow decrease in dosage (abruptly cancellation of the drug can not be given by the adrenal glands).

If the course of the disease is more turbulent, then, in addition to steroids, intravenously injected large doses of cytostatics. This pulse therapy is carried out for six months. And only after this period you can start to reduce the dose of drugs and transfer the patient to oral medication.

Do not forget that patients with SLE often develop DIC syndrome, so it is recommended to take preventive measures, namely:

• Transfusion of blood and its components;
• Intravenous administration of Trental;
• Subcutaneous injection of 2.5 thousand units of "Heparin".

The second stage of treatment

Lupus-nephritis with SLE in the second stage is also treated with steroid hormones and cytostatics. Only their dose is much less. Very slowly, within four to six months, the dose of "Prednisolone" is titrated to 10 milligrams per kilogram of weight. Cytotoxic drugs are also prescribed in bolus doses once every three months, and if the positive dynamics of the disease persists, they switch to a single injection in six months.

Such supportive therapy can last for years. Over time, it is added (if necessary) to prevent side effects from drugs and symptomatic treatment.

But even with timely treatment, fifteen percent of patients still develop kidney failure. In this case, only hemodialysis sessions or kidney transplantation can help. Unfortunately, such methods of treatment are not available to the general population.

Diet with lupus-nephritis

In order to maintain kidney function, patients with lupus nephritis should adhere to certain rules:

1. Drink plenty of fluids to filter blood well and maintain a level of metabolism.
2. Food should contain a small amount of potassium, phosphorus and protein, as these elements negatively affect the damaged kidneys.
3. To refuse from bad habits.
4. Engage in easy sports.
5. Regularly check blood pressure.
6. Limit the intake of fatty foods.
7. Do not take NSAIDs, as they negatively affect the kidneys.

If the patient follows these recommendations, the quality of his life improves significantly, and the survival prognosis becomes more promising.

Forecast

The prognosis of treatment of membrane-lupus nephritis depends on how seriously the kidneys are affected and the timing of the initiation of therapy. The earlier a patient consults a doctor, the greater the likelihood of a favorable outcome.

Forty years ago, only a few patients with lupus nephritis lived more than a year from the time of diagnosis. Thanks to modern methods of treatment and diagnostics, patients can count on more than five years of life.