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Thread: Lupus Nephritis Mixed Class (Stage ?) III and V diagnosis

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    Default Lupus Nephritis Mixed Class (Stage ?) III and V diagnosis

    Hi all,

    It's been awhile since I've written in this forum as I've been going through many fun new medical stuff. I think the last time I had written I'd just had my kidney biopsy. Well, I know have a diagnosis and a preliminary treatment plan but I'm not sure I fully understand what it all means. So, I'm asking all of you out there for some help in deciphering all of this.

    I've been diagnosed with Nephritis Mixed Class (or stage?) III and V. I know I have lost 30% of my kidney function, that I have both past and present scarring and inflammation, and that some kind of deposit or something is being placed in the inside lining of the tubes in my kidneys. Also, I am losing 7,000mg of protein per day. My doc is starting me on a high dose of an ACE Inhibitor, Cellcept, and 40 mg of steroids. However, he did warn me that I may have to start on Cytoxin if the Cellcept doesn't work in 4 months.

    Does anyone have a clear understanding of what it means to have mixed class III and V? What is the prognosis and general outcomes?

    What about Cellcept? What have been people's experiences?

    Any help would be greatly appreciated.

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    I don't know about the mixed stage, but I am on Cellcept and it seems to be working well and I can't say that I have had many side effects, if any that I can remember. I started CellCept in November. I am also on prednisone and plaquenill. I was previously on IV Cytoxan.

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    Following are the classes of Lupus Nephritis:
    The World Health Organization has divided lupus nephritis into five classes based on the biopsy:
    Class I is histologically normal and does not show any evidence of disease.

    Class II is based on a finding of mesangial lupus nephritis. This form typically responds completely to treatment with corticosteroids.

    Class III is focal proliferative nephritis and often successfully responds to treatment with high doses of corticosteroids.

    Class IV is diffuse proliferative nephritis. This form is mainly treated with corticosteroids and immunosuppressant drugs.

    Class V is membranous nephritis and is characterized by extreme edema and protein loss.

    Class VI is Glomerulosclerosis (scarring of the kidneys' tiny blood vessels, the glomeruli. One sign of glomerulosclerosis is proteinuria (larger amounts of protein appearing in the urine) because the scarring disturbs the kidneys' filtering process and allows protein to leak from the blood into the urine). Scarred glomeruli cannot be repaired. Many patients with glomerulosclerosis may get worse until their kidneys fail completely. This condition is called end-stage renal disease or ESRD. Patients with ESRD must go on dialysis (hemodialysis or peritoneal dialysis) to clean their blood or get a new kidney through transplantation. The best treatment for glomerulosclerosis depends upon what caused the scarring. This is determined by renal biopsy. Immunosuppressants -- drugs that block the body's immune system -- stop proteinuria in about half of the patients with glomerulosclerosis. But when the course of treatment is over, proteinuria may return for many patients. In some cases, the drugs actually may end up hurting the kidneys of certain patients.

    Most doctors try to slow down the progression of kidney failure by controlling the patient's blood pressure. This is one of the most important tools available. A class of blood pressure medicines called ACE inhibitors appears to preserve kidney function in patients with diabetes. Further studies may show that ACE inhibitors slow down kidney failure even in patients who do not have diabetes. Some doctors advise their patients to go on a low-protein diet to lighten the load of wastes on the kidneys. Some kidney patients may need to control their cholesterol through diet or both diet and medicine.

    Here is a brief explanation of some of the terms used above:

    Diffuse = not concentrated or localized

    Diffuse Proliferative Nephritis = a term used to describe a distinct histologic (The microscopic structure of tissue from biopsy)form of glomerulonephritis (a type of kidney disease caused by inflammation of the internal kidney structures known as glomerul) common to various types of systemic inflammatory diseases like Lupus. More than 50% of the glomeruli (diffuse) demonstrate increased mesangial (specialized cells around blood vessels in the kidneys), epithelial (epithelial tissues are found on a surface of organs -They are distinguished from each other by their differences in cell shape and cell orientation. In all cases the cells are tightly connected), endothelial ( the thin layer of cells that line the interior surface of blood vessels), and inflammatory cells (ie, glomerulonephritis).
    When fewer than 50% of the glomeruli are involved, the condition is termed focal proliferative and has the potential to progress to Diffuse Proliferative Glomerulonephritis. The diagnosis is often suspected in a patient presenting with systemic inflammatory disease (such as Lupus) who manifests hematuria(blood in the urine), proteinuria (protein leak in the urine), and active urinary sediment (which red cells, white cells, oval fat bodies, and all types of casts are found) or azotemia (ie, rise in serum blood urea nitrogen, creatinine); histologic findings from kidney biopsy tissue are used to confirm the diagnosis.

    You have been diagnosed with mixed symptoms of stage 3 and 5 because you have protein leakage, blood in your urine, scarring, and blockage (a combination of symptoms in class 3 and 5). Your course of treatment (as outlined above) is standard for the symptoms you are exhibiting.

    I hope that I've answered your question. Please let me know if you need anything further in the way of explanations.

    :lol: :lol:
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    Thank you Saysusie. Do you have any idea of the typical prognosis in my case? I know it is difficult to say and that every person responds differently to treatment, etc. but I'd like to know whether I should expect to be on dialysis in the next couple of years. So far, my doctors (although excellent) have been pretty vague about the expected outcomes.

    Thank you!

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    Hi ldrinker -

    I had Type 4, with lots of proteinuria and permanent scarring. I used the same meds you are going to start and was able to get my kidneys back under control (I also added acupuncture, which I think really helped). I didn't have too many side effects from Cellcept at all and it was very successful. I will hold the same hope for you. I, fortunately, never had to switch to Cytoxan, although I did get close once.

    Prognosis is really going to depend on how your body reacts to this mode of treatment. You will have some idea after 4-6 weeks. They probably have you getting labs every two weeks at this point, I imagine.

    Best of luck and take care!
    Missy

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    I agree with Missy regarding treatment and prognosis. Your treatment modality depends greatly upon a number of things (such as: presence of or lack of anti-double stranded DNA antibody (anti-DNA), or if you have high anti-DNA titers accompanied by hypocomplementemia, or if you have decreasing C3, results of renal biopsy, among other considerations).
    In general, the long-term prognosis of patients with proliferative lupus nephritis may be better than usually thought. Favorable factors for good long-term outcome are the achievement of complete renal remission due to aggressive treatment. Many patients achieve an absence of nephritic flares and their symptoms sometimes completely reverse after treatment. Hopefully, this will be the case for you. But, there is absolutely no way that any one can give you a definitive answer regarding your prognosis. There are too many variables that must be taken into consideration. :?

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    Thank you guys so much for your responses. I have started seeing a naturopathic doctor and begun a regular exercise routine and have eliminated wheat, dairy and alcohol from my diet. I also plan on beginning acupuncture treatments. I think it's helping. I'm feeling like this thing is totally controllable (or at least I hope it is). I'll keep you posted.

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    I agree and I do hope that you are successful in controlling your symptoms and, hopefully, becoming symptom free!


    Peace and Blessings
    Saysusie
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    That positive attitude is going to get you far, as well!
    Missy

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