I'm a bit curious at the moment about lupus nephritis. I've been on plaquenil for my lupus for almost three years and one thing that showed in my recent tests was protein in the urine (microalbuminuria). I haven't been to see my rheumatologist for a while so I haven't been able to discuss what this means. If it's a result of taking plaquenil I imagine almost all lupies must have that problem, am I right? Or is it more likely to be the lupus causing damage to my kidneys? I am also wondering for those of you who have had kidney biopsies what made your doctors decide to do that?
Developing Lupus Nephritis because of Plaquenil is not impossible, but very, very, very rare.
Lupus nephritis is inflammation of the kidney that is caused by systemic lupus erythematous (SLE). With lupus, the body's immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys causing inflammation in that organ. Up to 60% of lupus patients will develop lupus nephritis. When the kidneys are inflamed, they can't function normally and can leak protein. If not controlled, lupus nephritis can lead to kidney failure.
For many, the first noticeable symptom of lupus nephritis is swelling of the legs, ankles and feet. Sometimes, there can be swelling in the face or hands.
Other symptoms can vary from person to person and from day to day. They may include: Weight gain, high blood pressure, Dark urine, Foamy - frothy urine, The need to urinate during the night. Not all urinary or kidney problems in people with lupus are due to lupus nephritis. People with lupus may also be prone to urinary tract infections. These cause burning urination and require treatment with antibiotics.
There are some lupus medications that can affect the kidneys and cause swelling and other symptoms similar to those of lupus nephritis. Plaquenil is not listed as one of those drugs. Problems related to these drugs usually go away when the drugs are no longer used.
There are five different types of lupus nephritis and the treatment is based upon what type of lupus nephritis the patient has. The type of nephritis is usually determined by a kidney biopsy. Since symptoms and severity of this condition vary from person to person, treatments also vary from person to person and are tailored to meet a person's particular circumstances.
Medications used in treatment can include:
- Corticosteroids. These strong anti-inflammatory drugs can decrease inflammation. Doctors may prescribe these until the lupus nephritis improves. Because these drugs can cause a variety of potentially serious side effects, they must be monitored carefully. Doctors generally taper down the dosage once the symptoms start to improve.
- Immunosuppressive drugs. These drugs, which are related to the ones used to treat cancer or prevent the rejection of transplanted organs, work by suppressing immune system activity that damages the kidneys. These medications include: cyclophosphamide (Cytoxan), azathioprine (Imuran) and mycophenolate (Cellcept).
- Medications to prevent blood clots or lower blood pressure if needed. Even with treatment, loss of kidney function sometimes progresses. If both kidneys fail, people with lupus nephritis may need dialysis. Dialysis involves filtering the blood through a machine to remove waste products from the body.
Ultimately, it may be necessary to have a kidney transplant. In those cases, people will need additional drugs to keep their immune system from rejecting the transplanted kidney.
There are some lifestyle habits that you can employ to help protect your kidneys. People with lupus nephritis should do the following:
- Drink enough fluids to stay well hydrated.
- Eat a low-sodium diet, especially if you have hypertension.
- Stop smoking and avoid drinking alcohol.
- Exercise regularly.
- Maintain a healthy blood pressure.
- Limit your intake of cholesterol.
- Avoid medications that can affect the kidneys, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Your doctor may also recommend that you eat a diet low in potassium, phosphorus, and protein if there is already loss of kidney function. Although lupus nephritis can be a serious problem, most people who receive treatment do not go on to have kidney failure.
I hope that this information has helped you and I wish you the very best.
Peace and Blessings
Thanks Saysusie, that information is very helpful. I thought it would be unusual for the plaquenil to cause kidney damage because that is what it is trying to protect against. I see my new rheumatologist in a month and I'm having more kidney tests in the meantime so I'll be interested to see what comes of this. Thanks again for your help:)