New Guidelines Issued for Severe Lupus05/03/12
THURSDAY, May 3 (HealthDay News) -- When diagnosed with lupus,
one in three people already has kidney inflammation, and during the
first 10 years with the disease as many as 60 percent of patients
will have some kidney problems.
Because kidney inflammation (also called lupus nephritis) is so
common in people with lupus, the American College of Rheumatology
has issued new guidelines for the screening and management of this
potentially devastating complication of lupus.
"Without treatment, lupus nephritis can lead to end-stage-renal disease, which requires dialysis or a kidney transplant. But, not all types are this serious. It depends on the pattern of damage to the kidneys," said the lead author of the new guidelines, Dr. Bevra Hahn, a professor of medicine and chief of rheumatology at the David Geffen School of Medicine at the University of California, Los Angeles.
Hahn said the course of lupus nephritis can vary greatly from
patient to patient. And, that means that treatment decisions need
to be individualized.
The guidelines, released online May 3, will be published in the
June issue of
Arthritis Care & Research.
Lupus -- short for systemic lupus erythematosus (SLE) -- is a
chronic autoimmune disease. That means that the body's immune
system mistakenly attacks healthy cells in the body. The most
commonly affected areas are the joints and skin, but lupus can
affect any body part, including the kidneys. The disease is mild in
some people and more severe in others. There are also symptom-free
periods of time, and then the disease flares again.
If the kidneys are involved, quality of life and survival rates
suffer. Normally, the survival rate is 92 percent after 10 years
with lupus. If the kidneys are involved, survival drops to 88
percent, according to the guidelines. Blacks have an even lower
survival rate when the kidneys are affected.
Fortunately, treatments exist for people with lupus
If you haven't received treatment for lupus nephritis, and you
show signs of kidney involvement, the first step is generally to
get a kidney biopsy, according to the guidelines. This is so your
doctor knows exactly what type of lupus nephritis you have, how
aggressive it is, and how much of the kidney is damaged. This
information helps to guide treatment decisions, Hahn said.
She said everyone with lupus nephritis should be given the drug
hydroxycholoquine, and if there's any sign of protein in the urine,
they should also be on blood pressure-lowering medications called
ACE inhibitors or angiotensin-receptor blockers (ARBs). These have
a protective effect on the kidneys, independent of their ability to
lower blood pressure. If cholesterol is high, it's important to get
the "bad" (LDL) cholesterol under control, said Hahn.
For more serious disease, drugs that suppress the immune system
and reduce inflammation are recommended. These include
glucocorticoids, azathioprine and mycophenolate mofetil.
Despite new treatments, however, the rate of end-stage renal
disease has increased since 1982. Hahn said it isn't clear why
that's happened, and she hoped more recent data will show an
improvement with use of some newer treatments.
Dr. Richard Furie, chief of the division of rheumatology at the
North Shore-LIJ Health System in Lake Success, N.Y., welcomed the
"These new guidelines will add some uniformity to the way we approach lupus nephritis," he said.
Furie added that while newer treatments have helped treat people
with lupus, "they don't do such a great job with lupus nephritis. A
really good response only occurs in about 25 to 50 percent of
Both experts said that people with lupus should follow the
advice for heart-healthy living. That means don't smoke, eat right
and try to get some exercise.
Hahn said to aim for at least 15 minutes of walking three to
four times a week. "Try to keep yourself in good aerobic shape.
And, if you can do more, that's better." But, she said, it's also
important to rest when you need to.
As for diet, Hahn said previous research has shown that a diet
heavy in trans fats or meat fats promotes inflammation, so it may
help to avoid those types of foods.
The most important thing, Hahn said, is to stick with your
medication regimen. And, if you can't take your medication because
of side effects or cost, it's important to discuss that with your
Learn more about lupus nephritis from the
U.S. National Institute of Diabetes and Digestive ...
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