In practice, lupus nephritis is the key to treating lupus. Patients often have many questions and confusion about the condition and treatment of nephritis. However, due to the tight clinic schedule, there is not enough time to answer all of them.
1. Can the development of nephritis be avoided with well-controlled lupus?
Yes, it can be avoided. Our experience is that nephritis rarely appears in new patients who are detected early and treated promptly, or in older patients who have been in stable remission for a long time.
2. When nephritis symptoms appear in lupus patients, should we first control the kidney damage or continue to treat the primary lupus disease?
It is necessary to take both into consideration.
(1) Give priority to drugs that can both treat nephritis and control the overall lupus condition.
(2) Continue treatment of the primary lupus erythematosus, which would have helped to control the renal damage.
3. Which immunosuppressive drugs are commonly used to treat lupus nephritis, and are they different from those selected for lupus treatment and their dosage?
Cyclophosphamide, mycophenolate (also called morte-malcophenolate), azathioprine, and leflunomide are commonly used to treat lupus nephritis. The above drugs are generally used less often in “common mild lupus”; even if they are chosen, their dosage is low.
4.What is cyclophosphamide shock therapy and do all patients with lupus nephritis need to use it?
Cyclophosphamide shock therapy is a common treatment for severe lupus (including severe lupus nephritis), which refers to the use of large amounts of cyclophosphamide in a short period of time (the dosage varies from person to person), similar to the “crackdown” campaign conducted by the Public Security Bureau. It is not necessary for all patients with lupus nephritis, but only for type 3 and type 4 lupus nephritis. The actual kidney biopsy should be carried out safely, and a plan should be made according to the kidney pathological changes, so as to avoid unnecessary “severe fighting” and achieve “fine fighting”.
5. If a patient with lupus nephritis needs to prepare for pregnancy, what are the precautions for medication?
Remember the following principles.
(1) Select the right time after the disease is fully controlled.
(2) Avoid drugs that affect reproductive function, or try to use them in small doses.
(3) Pregnancy medication is beneficial to the fetus, do not recognize the deadly principle that “all drugs are toxic”.
(4) Optional drugs are hydroxychloroquine, a small amount of hormones, azathioprine, etc.
(5)Cyclophosphamide, mycophenolate, leflunomide, methotrexate, etc. are prohibited and many drugs are not available.
6.What tests should be done to evaluate the treatment effect of lupus nephritis and how often?
Humanized arrangements should be made according to the priority of the disease, historical changes of the indicators, the distance of the address and the arrangement of work and family. In the early stages of treatment, close follow-up examinations are usually done once a month, and later the interval between examinations is extended. For example, after the treatment is stabilized, students from overseas will have two follow-up examinations every summer and winter holidays.
7.If the autoantibody test passes, and the urine protein and creatinine are normal, does that mean the nephritis is under control?
It is not possible to make a generalization. For example, autoantibodies such as anti-double-stranded DNA (ds-DNA) antibodies can be used as an indicator of how good nephritis is. A decrease in urine protein also generally indicates improvement, but it should be analyzed in the context of urine red blood cells and urine tubular pattern. Interestingly, some patients who had a lot of proteinuria (the blood protein is pulled away from the urine, so the blood protein is reduced), after effective treatment, the urine protein is reduced (so the blood protein is also restored to elevated), then although the nephritis improves, but the autoantibody index will “worsen” (because the nature of autoantibodies is also the protein). Blood creatinine is the least reliable, because it often rises only when more than half of the kidney function is lost. Therefore, you can’t just rely on “laboratory tests” to make a conclusion, but should be considered in a comprehensive manner.
8.Can immunosuppressive drugs cause kidney function damage?
Yes, for example, cyclosporine A and so on. However, they are used less frequently in clinical practice. It is worth pointing out that some patients with lupus take some “painkillers” for joint pain, which also have certain effects on the kidney.
Can biologics be used in the treatment of lupus nephritis?
Although other rheumatic diseases such as rheumatoid arthritis and ankylosing spondylitis already have powerful drugs such as biologics, biologics specifically for lupus nephritis are not yet available. However, one thing can be forewarned that there is a new biologic agent abroad: belinumab, which has been marketed in the United States and has certain effects on nephritis. At this stage, clinical trials have been conducted in many major units in China, and it is believed that it can be marketed in China in the near future for the benefit of domestic patients.