Kidney pathologies are independent, or develop against the backdrop of other pathological processes in the body. A vivid example of secondary renal diseases, deserving special attention, is lupus nephritis.
Lupus nephritis is an inflammation of the kidneys that develops in the background of red systemic lupus, which is a vast immune-mediated inflammatory lesion of connective tissue structures. This is a kind of immune defect, in which an active formation of protein autoantibodies that cause inflammatory processes is observed.
Inflammation affects the skin and joint structures, lung and heart, but the most life-threatening are kidney and neuromuscular lesions. According to statistics, lupus nephritis occurs in about 50-70% of cases of systemic lupus. And in women, this disease is more common than in men 9 times.
Morphological picture of pathology is characterized by diversity. In addition to histological changes, there are specific symptoms characteris
tic of nephritis of lupus origin. Mechanisms of pathological development are that there is a violation of recognition of their own organic antigens, as a result, active production of autoantibodies begins.
Hence the symptomatic variety of systemic lupus, and nephritis is only one of its many concomitant lesions. Symptoms of systemic lupus erythematosus
There is no single theory explaining the emergence of red systemic lupus, therefore specialists define a group of factors that can lead to this pathology:
- Female hormones of the reproductive system. Estrogens often act as triggers for the development of systemic lupus. This partly explains the propensity of the female population to this pathology. In addition, systemic lupus often manifests during pregnancy, when the estrogen level is at the maximum level.
- Heredity. Specialists note a certain pattern in the development of such a disease in people with relatives with a similar pathology. Especially high incidence among twins. Also a tendency to systemic lupus is observed in Afro-Caribbean ethnic groups, where pathology is detected 10 times more often.
- Presence in the anamnesis of infectious-viral pathologies. Especially dangerous and most often leading to the development of lupus viruses are retroviruses, paramyxoviruses, measles viruses, etc. However, the viral theory is still being studied and requires additional evidence. Although the available research results allow us to consider it as a significant factor.
- Medications. It has been clinically proven that prolonged use of drugs such as methyldopa or isoniazid can trigger the development of pathology.
- Excessive insolation. A significant influence on the development of systemic lupus erythematosus of excessive ultraviolet radiation has been proved.
On video, the effect of systemic lupus erythematosus on the kidneys:
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External signs of lupus nephritis differ in variety.
The final clinical picture is composed of the characteristics characteristic of nephritis and lupus in general:
- Skin lesions. They are manifested by erythematous( red-colored) lesions on the face skin in the form of a butterfly. Often there are eruptions in other areas of the body.
- Renal lesions.
- Hyperthermia, which can reach high rates.
- Vascular lesions, which consist in inflammation of small vascular channels at the fingertips. Less often, the capillarite affects the palms and soles.
- Joint lesions, which are manifested by arthritis of small articular structures.
- Cardiac lesions - myocarditis, pericarditis, endocarditis.
- Pulmonary lesions, which are manifested by pleurisy and fibrosing alveolitis.
- Lupus cerebrovascular disease.
- Trophy disorders like alopecia, rapid weight loss, nail bundle.
A more specific symptomatology depends on the type of lupus nephritis.
Specialists distinguish several varieties of nephritis of lupus origin. In accordance with the severity of inflammatory changes, lupus nephritis is divided into diffuse and focal jaws, with or without glomerulonephritis. In addition, lupus nephritis is divided into the following forms:
- Inactive nephritis - accompanied by subclinical proteinuria and minimal urinary syndrome;
- Active lupus nephritis, which is also classified into several forms:
- Rapidly progressive;
- Slowly progressive( with urinary or nephrotic syndrome).
The clinical manifestations are rapidly increasing, generally reducing to a pronounced nephrotic syndrome:
- The patient is worried about severe puffiness, up to a massive accumulation of fluid in various cavities, for example, in the heart, peritoneum, pleura, etc., and there is swelling of the legs.
- There is a pronounced hypertensive disease, and high blood pressure indicators are difficult enough to give in to traditional medical correction.
For slowly progressing lupus nephritis, a milder and benign course is characteristic. It accounts for about 40% of all lupus nephritis. If slowly progressing lupus nephritis is accompanied by a nephrotic syndrome, swelling is poorly expressed. Hypertensive disease in such cases is easily corrected by medications.
If slowly progressing nephritis occurs with a urinary syndrome, then the clinic is also minimal, swelling is poorly expressed, and hypertension occurs in only half of the patients. A characteristic feature of this form is a noticeable change in the chemical composition of urine, in which blood, protein, and sometimes leukocytes are present. Classes of lupus nephritis
Diagnosis of lupus nephritis is simple enough, especially in the presence of a typical clinical picture of the underlying systemic disease, together with specific signs such as erythema on the face, fever, arthritis, etc.
Laboratory-diagnostic studies are mandatory, including:
- Thorough examinationurine for leukocyturia, hematuria, proteinuria;
- Blood tests that detect a deficit of leukocytes, less often erythrocytes and platelets, an increased rate of ESR;
The presence of autoantibodies and cells specific for systemic lupus are also revealed.
If, during lupus, a pathological inflammatory process affects the kidney tissues and signs of lupus nephritis appear, appropriate treatment should be started immediately. The main drugs used in the treatment of lupus are cytostatics and hormonal drugs, ie, Ciclosporin and Dexamethasone.
For lupus erythematosus of the kidneys, the following methods are recommended:
- Abstain from alcohol and tobacco smoking;
- Use the right amount of liquid to support the water balance;
- Do not eat foods that contain cholesterol;
- Use a minimum amount of food containing protein, phosphorus and potassium;
- Move more, perform movements from the exercise program;
- Monitor blood pressure, if necessary, keeping it medicated at the right level;
- Refuse to take drugs that adversely affect the kidneys( such as NSAIDs, etc.).
If lupus nephritis leads to an acute form of kidney failure, the patient is undergoing hemodialysis. In severe lesions, organ transplantation is indicated.
During remission periods, regular sanatorium treatment is recommended. All patients even after treatment are under clinical supervision with systematic preventive examinations of specialists with a narrow specialization( urologists, etc.).
The prognosis is due to the correctness and timeliness of the selected therapy. In young patients, pathology proceeds in a more severe form. In addition, the length of the period from the manifestation of systemic lupus to the onset of the development of lupus erythematosus is important. The predictions are also influenced by the sex of the patient, because in women the survival rate is much higher. Although the pathology is serious, but with timely and correct therapy, most patients with lupus nephritis live a completely normal life.