During her late 20s, Wendy Rodgers began to experience swollen feet, joint pain, and frequent, foamy urination. She started losing hair, gaining weight, and feeling exceptionally tired, but chalked it up to stress caused by a recent move from Texas to California.
"I just had a lot going on," Rodgers, now 44, told HealthCentral in an interview. After a morning of not being able to move normally, she contacted her primary-care provider. He measured her blood pressure at 225 over 125 and immediately prescribed anti-hypertensive medication.
Understandably worried, Rodgers, a science teacher, carefully read a women's health book and came cross a description of lupus. She thought: "I have this."
Her doctor didn't discount the possibility and referred her to a rheumatologist, a specialist in musculoskeletal and systemic autoimmune conditions. A urinalysis revealed Rodgers's kidneys were leaking protein, but the doctor said it "wasn't substantial."
She continued to deteriorate, and was referred next to a nephrologist, a specialist in kidney disease. More urine and blood tests, and a biopsy that surgically sampled a small piece of kidney, confirmed a diagnosis of lupus nephritis—inflammation of the kidneys—in February 2000.
Lupus and the kidneys
Lupus in general, also called systemic lupus erythematosus (SLE), is an autoimmune disease that can affect almost any part of the body, most often joints, skin, kidneys, heart, lungs, blood, or brain. The body essentially "attacks" itself.
According to the Lupus Foundation of America, lupus nephritis occurs when kidneys cannot properly remove waste from the blood or control the amount of fluids in the body. Kidneys also regulate hormones that control blood pressure and blood volume.
With lupus nephritis, waste build-up in the blood can scar and damage kidneys, ultimately causing end-stage renal disease. Treatments include dialysis to filter waste by machine. If the disease progresses, a kidney transplant may be the only option.
According to the foundation:
- Lupus usually affects people between ages 15 and 44; lupus nephritis typically affects people between ages 20 and 40.
- As many as 60 percent of those with lupus will develop kidney complications that require medical treatment. The rate is higher in children.
- Lupus nephritis usually develops within the first five years of the initial onset of general lupus symptoms.
- Lupus nephritis is more prevalent in African-Americans and Hispanics than in Caucasians, and develops more often in males than in females.
Don't guess about your health
“Lupus is such an unusual disease that when it presents early it can sometimes confuse patients and physicians and lead to a subsequent delay in diagnosis,” says nephrologist Brad Rovin, M.D. He is a professor of medicine and pathology at The Ohio State University Wexner Medical Center's department of internal medicine and nephrology and a member of the Lupus Foundation's medical science advisory committee.
He urges anyone who doesn’t feel well and has suspicious symptoms to contact their doctor as soon as possible. A person who receives a lupus diagnosis should also have kidney function immediately evaluated by a physician. If it appears abnormal, it should be further investigated, ideally by a nephrologist.
"The data suggest that if you can intervene earlier rather than later with lupus nephritis, the patient has a better prognosis for response to therapy," says Dr. Rovin.
Screening for kidney function is straightforward and should include a urinalysis to look for protein or blood, and a blood test for serum creatinine, a waste product excreted by the kidneys that is normally present at low levels.
Kidney function should then be checked regularly—at least once a year, Dr. Rovin says: "Patients can't see microscopic levels of blood in urine or protein.
Once diagnosed, lupus nephritis is initially controlled with immunosuppressive medications, says Dr. Rovin. These drugs suppress the body's immune system so it doesn't attack the kidneys. These medications may also be used to treat cancer or prevent rejection of organ transplants. Drug names include azathioprine, mycophenolate mofetil, and cyclophosphamide. Corticosteroids are also utilized, most commonly prednisone or methylprednisolone.
A new kidney and life