1. Can well-controlled lupus prevent the development of nephritis?
Patients with lupus are more likely to develop kidney-related diseases than other patients. Renal-related diseases can present with hypertension and edema. Lupus nephritis refers specifically to SLE-associated nephritis. Patients with SLE usually also have a combination of diabetes and hypertension, which can also lead to kidney damage and diabetic nephropathy and hypertensive nephropathy.
2. What are the symptoms of lupus nephritis?
A part of lupus nephritis may have no symptoms, but more than half of them will have the following symptoms: (1) swelling: mainly in the hands, face, feet and around the eyes; (2) weight change: weight gain or loss can occur; (3) weakness; (4) abnormal urine: brown, foamy, reduced urine volume; (5) hypertension.
3. What are the routine tests for lupus nephritis? Is a kidney biopsy required?
It mainly includes renal function (blood test), urine routine, 24h urine protein quantification, complement C3,C4, anti-dsDNA quantification, etc. Patients with lupus nephritis need to be rechecked at least once a month to monitor their condition. When the blood creatinine continues to rise, or 24-hour urine protein is greater than 1g, or 24-hour urine protein is greater than 0.5g and red blood cell mass, white blood cell mass or tubular type appear in urinalysis, factors such as infection, drugs and hypovolemia are excluded, and renal puncture examination is needed after excluding contraindications.
4.How is the treatment plan for lupus nephritis formulated?
The balance of immune system in lupus patients is disturbed and there are immune cells attacking their own cells. Drug therapy can partially suppress the immune system while delaying the damage to the kidney. There are many drug options for lupus nephritis. Doctors usually select 1 or 2 drugs first according to the type of pathology and clinical symptoms, and choose the best plan according to the treatment response.
5. How to apply adjuvant drugs in lupus nephritis?
The reasonable choice of adjuvant drugs can delay the disease and reduce complications. (1) Hydroxychloroquine: It can effectively reduce the recurrence rate, reduce kidney damage, and reduce the risk of embolism, and is recommended to be taken by patients with lupus nephritis without contraindications. (2) Angiotensin inhibitors (ACEI/ARB): they are better than calcium blockers in nephroprotective function, can reduce urine protein by 30%, delay doubling of blood creatinine and progression of end-stage nephropathy, and are recommended for all patients with urine protein >0.5g/24h, especially those with combined hypertension (blood pressure control target ≤130/80mmHg) (3) Statins: systemic lupus erythematosus is itself an independent risk factor for atherosclerosis, and lupus nephritis accelerates its progress. It is recommended that patients with elevated LDL and decreased glomerular filtration rate take them routinely.
6. How to choose the appropriate immunosuppressant according to the pathological type of lupus nephritis?
According to the 2012 ACR guidelines and expert recommendations: no special treatment is needed for type I/II lupus nephritis without clinical symptoms; type III/IV lupus nephritis induced remission regimen 1) primaquine + glucocorticoid shock therapy, evaluate the efficacy after 6 months, if remission is successful, primaquine or azathioprine + low-dose glucocorticoid maintenance therapy; if remission is not achieved, replace cyclophosphamide + glucocorticoid shock therapy regimen. (Option 2) Cyclophosphamide + glucocorticoid shock therapy, evaluation of efficacy after 6 months, if remission is successful, primaquine or azathioprine + low-dose glucocorticoid maintenance therapy; if remission is not achieved, primaquine + glucocorticoid shock therapy can be replaced; for patients who are not successful with the above treatment options, biologic melphalan or calcineurin inhibitor + glucocorticoid can be tried; induction of remission in patients with simple type V If remission is successful, primaquine or azathioprine should be used to maintain the remission; if not, cyclophosphamide + glucocorticoid shock therapy should be used. Type VI patients: dialysis treatment or renal transplantation needs to be considered.
7. What is cyclophosphamide shock therapy?
The efficacy of cyclophosphamide in inducing remission of lupus nephritis has been well established in many large-scale clinical trials. There are generally 2 regimens as follows: (1) low-dose regimen: cyclophosphamide 500 mg, IV, once/2 weeks, cumulative 6 times.
(2) High-dose regimen: cyclophosphamide 500-1000 mg/m2, IV, 1 time/month, cumulative 6 times. Clinical trial studies suggest that 30 months of cyclophosphamide treatment (1 time/month x 6 months + 1 time/3 months x 2 years) is significantly better than 6 months of treatment alone in controlling recurrence. However, cyclophosphamide can cause irreversible damage to reproductive function, so it is contraindicated in patients with reproductive requirements.
8.How long does it take to see the effect of treatment?
Generally speaking, after 8 weeks of treatment with cyclophosphamide and primaquine induced remission regimen, there are significant changes in proteinuria and complement C3, and after 6 months of treatment, most of the indicators can be improved in 50% of patients.
9. Can lupus patients get pregnant?
Pregnancy in patients with lupus nephritis is risky, with high fetal mortality before birth, and pregnancy itself can aggravate the condition of lupus nephritis, so it is important to consult your doctor before preparing for pregnancy. In general, it is relatively safe to wait at least 6 months until the symptoms of nephritis have disappeared. Patients who have previously used primaquine need to stop taking it for at least 6 weeks. A joint consultation with a rheumatologist and an obstetrician-gynecologist is also required throughout the pregnancy and perinatal period to jointly develop a treatment plan.
10. What is the treatment of lupus nephritis during pregnancy?
Generally speaking, no treatment is needed for inactive disease, and hydroxychloroquine is the treatment of choice for mild activity.
11.What should I pay attention to in the diet of lupus nephritis?
The dietary treatment of lupus nephritis should be formulated according to the degree of damage to renal function. The principle of dietary treatment is to restrict protein diet. Patients with edema and hypertension need to restrict water and salt intake at the same time, as well as cholesterol, saturated fatty acids and phosphorus intake in food, and adequately supplement calcium, various vitamins and folic acid. For patients with mild renal impairment, protein should be controlled at 1g/kg, while for moderate to severe patients, 0.6-0.8g/kg, of which 50% should be high quality protein (milk, egg whites, white meat, red meat, etc.). For example, for patients weighing 60 kg, with blood creatinine 200 micromol/liter, edema and hypertension: protein intake 36-48g/day, including 20g of high quality protein (equal to 1 cup of milk + 1 egg + 1 portion of meat (100g)); salt 2-3g/day (<2g for severe edema and hypertension, or even a salt-free diet); water intake depends on the edema situation: no edema No need to restrict water intake; reduce water intake in case of mild edema; restrict water intake in case of obvious edema; reduce urine output (daily water intake = urine output of the previous day + 500ml)