What is lupus nephritis?
Lupus nephritis is a certain type of kidney inflammation (nephritis) that affects children with systemic lupus erythematosus (SLE). It is an autoimmune condition.
Normally, the job of the immune system is to find and destroy foreign invaders, like germs.
An autoimmune condition is one where the body starts to attack itself after mistakenly recognizing its cells as the ‘enemy’.
In lupus nephritis, the immune system attacks the kidneys, particularly the tiny filtering units within the kidneys (glomeruli), stopping them working as well as they should.
How is lupus nephritis diagnosed?
A doctor will ask lots of questions about how the child became ill and examine them. Various tests will be needed to confirm or end lupus nephritis:
- Urine tests to see if protein is present in the urine
- Blood tests to examine kidney function and specific lupus tests
- Kidney biopsy to see if any areas contain inflammation
- Other tests may also be needed if the results of these tests are not completely clear
What causes lupus nephritis?
Lupus nephritis only affects children with systemic lupus erythematosus (SLE). It is an autoimmune disease that is caused by the body’s immune system going into overdrive and attacking healthy tissue.
What are the symptoms of lupus nephritis?
The symptoms of lupus nephritis are similar to different conditions that also affect the glomeruli. Blood can be found in the urine, which can be discovered by test sticks.
There can be swelling caused due to rise in fluid in the body, which is not being extracted by the kidneys as it should. It can cause puffiness, mainly around the eyes, tummy, feet and legs, and weight gain. The medical word used for this puffiness is called oedema.
The appearance of the urine changes so that it appears foamy, which is a sign of proteinuria. The blood pressure can rise too.
Other symptoms of being generally unwell are common, such as loss of appetite. These are also caused by the puffiness that can further affect internal organs, like the digestive system, as well as the hands, feet and legs.
How is lupus nephritis treated?
The standard treatment is having steroids in combination with immunosuppressive medicines, which damp down the immune system and stop it attacking the glomeruli.
Doctors use different immunosuppressive medicines. The most common are cyclophosphamide, azathioprine and mycophenolate (MMF).
The initial treatment with cyclophosphamide is often given as an intravenous infusion every 4 weeks or so at the start, but can then change to oral tablets or medicines.
This immunosuppressive treatment will need to be done for a long time, often several years, to keep good control of the lupus.
The amount of protein lost in the child’s urine is monitored regularly. If the protein in the urine is high, medicines called ACE inhibitors are used to reduce the protein loss. Sometimes, diuretics (water tablets) are also prescribed to reduce the puffiness.
Whether a child is taking steroids or immunosuppressive medicines, some of their immunizations may have to be postponed while taking them.
Families should also report to their family doctor if the child comes into contact with chicken pox unless he or she has already had it.