Lupus and the Kidneys

From the 2012 Lupus Education Series

Two leading lupus specialists spoke to patients and their family and friends at the Jacobi Medical Center with information about lupus diagnosis and treatment. Both focused particularly on patients whose kidneys have been affected by lupus, a condition called lupus nephritis that affects TV personality Nick Cannon.

Here are their presentations for those who could not attend.

Julie Schwartzman-Morris, MD
Julie Schwartzman-Morris, MD

Dr. Schwartzman-Morris provides detailed information about how systemic erythematosus lupus, and lupus nephritis in particular, is diagnosed and treated. Following are some of the most interesting points from her presentation:

Response to Treatment: Chronic Kidney Disease Versus Active

  • Patients with lupus nephritis (kidney disease related to lupus) are more likely to progress to end-stage renal disease if they have a high degree of chronicity. Chronicity indicates that the damage has occurred over time.
  • Patients with a lot of activity and low chronicity respond better to treatment. Measuring activity means measuring how much the kidneys are inflamed at the moment.
  • Patients with high chronicity and low activity do not respond to treatment as well.

Treatment Decisions

  • The patient and physician must decide together when treatment is not working well and kidney dialysis is indicated.
  • Delaying dialysis too long can cause more kidney damage.
  • Five-year survival is the common measurement of treatment success. 90 percent of lupus patients on dialysis hit the five-year survival rate.
  • Response and success rates for SLE patients who have a transplant are the same as for people who have kidney transplant for other reasons.

Dr. Schwartzman-Morris is an Associate Professor of Clinical Medicine at the Albert Einstein College of Medicine. She is currently the Rheumatology Fellowship Training Program Director and Director of the Lupus and Arthritis Clinics at Jacobi Medical Center and North Central Bronx Hospital.

Naheed Ansari, MD
Naheed Ansari, MD – Dialysis and Transplant for Lupus Nephritis

Dr. Ansari’s presentation offered additional information on lupus nephritis from recognizing its signs through treatment. Following are key learnings from her talk:

Lupus Nephritis Diagnosis

  • Some of the symptoms of lupus nephritis include rash, oral or nasal ulcers; joint swelling; brown or foamy urine; and changes in the amount of urine.
  • Lupus nephritis is diagnosed by tests of the blood and urine and a surgical procedure to examine a sample of tissue from the kidney.
  • Once lupus nephritis is diagnosed, the goal of treatment is to get the kidneys back to normal.

How is Lupus Nephritis Treated?

  • There are two phases of treatment – induction and maintenance.
    • Induction means that intensive treatment is started to repress symptoms
    • Maintenance means that treatment is continued to prevent kidney disease from progressing
    • Kidney damage called End stage renal disease (ESRD) can occur when symptoms progress; 15-30 percent of people with lupus nephritis develop ESRD
  • Dialysis and kidney transplants are often needed to treat ESRD.
  • Two types of dialysis — hemodialysis and peritoneal remove waste products from your blood when your kidneys can no longer do the job.
    • Patients who choose hemodialysis must visit a dialysis center to have their blood filtered through a hemodialysis machine. During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) clear out wastes, with the help of a fluid that flows into and out of the peritoneal space. Many patients and/or caregivers can be trained to do peritoneal dialysis at home.
  • Kidney transplant is under-utilized as a treatment option.

Naheed Ansari, MD is attending physician in Nephrology Division at Jacobi Medical Center and Associate Professor of Clinical Medicine at Albert Einstein College of Medicine. She is a member and fellow of American Society of Nephrology and serves on the editorial board of the prestigious professional publication, American Medical Journal.

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