Protein in the urine is an indication that there may be kidney involvement with your Lupus. Kidney involvement in lupus rarely causes discomfort or pain (like kidney stones or infection). This is the most common kidney problem in Lupus -protein leakage in the urine. This can be mild and detected only on testing, or severe gradually leading to a lowering of the protein level in your blood (a low albumin level). When this happens there is a tendency for your ankles to swell, for you to have fluid retention and to have general fluid bloating.
If you are losing protein in the urine ('proteinuria'), then the amount will need to be quantified. For this, most doctors order a 24-hour urine collection. All the urine over a full 24-hour period is collected and the precise amount of protein lost over this period is measured. A sample of the urine is also sent to a laboratory for analysis for bacteria and for a microscopic examination.
Normal urine under the microscope is clear but when there is inflammation anywhere in the urinary tract (in the kidneys or the bladder) cells are present, either red cells or white cells. More important is the presence of clumps of cells called 'casts'. These clumps are indicative of kidney inflammation rather than a bladder inflammation and is of vital importance in the diagnosis and assessment of kidney involvement in Lupus.
When the kidney is inflamed the blood pressure frequently rises and blood pressure measurement is one of the important parts of the physical examination of lupus patients. When the kidney is more severely damaged its normal filtering process is grossly impaired and toxic elements such as urea and creatinine, normally present in the blood in small amounts, build up leading to weight loss, nausea and general malaise.
If your doctor finds that there is kidney inflammation, a combination of steroids and an immunosuppressive medicine is usually prescribed. For active or severe kidney disease, the most widely used immunosuppressive is cyclophosphamide given intermittently by injection. In the olden days cyclophosphamide was given as a tablet but this produced more side-effects and most doctors have now converted to giving intermittent 'pulses'. This comes in the form of a drip given into the vein, usually given weekly for three weeks then monthly for 3-12 months. Doses vary from clinic to clinic, but the more modern fashion has been to use lower doses than those previously used and this has the benefit of far less side-effects.
A milder immunosuppressive that is often used is azathioprine. This is given as tablet-form usually at a dose of about 2’mg/kg body weight.
All immunosuppressives can affect the blood count and regular blood counts will be done regularly if you on taking these meds.
Other immunosuppressive drugs such as cyclosporin-A are also being used increasingly, however, the two mainstays of treatment remain cyclophosphamide and azathioprine.
I hope that this has been helpful! I wish you the best!
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