Indications for renal biopsy in patients with lupus nephritis

This is an automatically translated article.

With lupus, the body's immune system attacks the body's own tissues. Up to 60% of lupus patients will develop lupus nephritis, which occurs when lupus autoantibodies affect structures inside the kidneys that filter waste.

1. Symptoms of Lupus Nephritis

Lupus nephritis (English name Lupus nephritis) is a common complication in people with systemic lupus erythematosus or lupus for short.
Lupus is an autoimmune disease in which the patient's own immune system produces proteins called autoantibodies, and these autoantibodies attack the patient's tissues and organs, including the kidneys. Lupus nephritis occurs when lupus autoantibodies affect the structures inside the kidneys that filter waste. This mechanism causes kidney inflammation and can lead to blood in the urine, protein in the urine, high blood pressure, impaired kidney function or even kidney failure.
Signs and symptoms of lupus nephritis include:
Blood in the urine Foamy urine (due to excess protein in the urine) High blood pressure Swelling in the hands, ankles or feet Creatinine levels increase in blood

2. How does lupus affect the kidneys?

Lupus nephritis is the term used when lupus causes inflammation in the kidneys, leaving the nephrons (the structures inside the kidneys that filter the blood) either unable to remove waste from the person's blood or out of control. liquid in the body.
If left untreated, abnormal amounts of waste can build up in the blood during Lupus nephritis which can lead to scarring and permanent damage to the kidneys and possibly end-stage renal disease (ESRD). People with ESRD need regular dialysis to remove body waste by machine or a kidney transplant for at least one kidney to function properly.
Lupus nephritis usually appears within the first five years after symptoms of lupus begin. This disease usually affects people between the ages of 20 and 40. In the early stages of lupus nephritis, there are very few signs to detect kidney inflammation. Often the first symptoms of lupus nephritis are weight gain and swelling in the feet, ankles, feet, hands, and/or eyelids. This swelling usually becomes more intense throughout the day. In addition, the urine may be foamy or frothy or red. However, if you have regular checkups, the first signs of lupus nephritis often show up on urinalysis.

Experts estimate that up to 60% of people with lupus and up to two-thirds of children with lupus will develop lupus nephritis and kidney complications that require evaluation and treatment. Up to 25% of people with lupus will develop end-stage renal disease or kidney failure.
Urinalysis is very important because there are very few symptoms of kidney disease to detect early. Severe damage to the kidneys can occur before a person is diagnosed with lupus.
Tests commonly used by doctors to diagnose lupus nephritis are: Urinalysis, usually over a 24-hour period; blood tests; and kidney biopsy.

3. Indications for kidney biopsy in patients with lupus nephritis

Kidney biopsy is done in the hospital, the patient will lie on his stomach, the doctor will insert a very thin and long needle through the skin of the back, removing a small piece of tissue from one of the patient's kidneys . The kidney tissue is then examined under a microscope to determine the extent of inflammation or scarring.
According to experts, kidney biopsy is the best technique for early diagnosis of nephritis in patients with Lupus. Besides, kidney biopsy is also used to monitor and evaluate the results of the treatment process.
Currently, there are five different types of lupus nephritis, so the treatment of lupus nephritis needs to be determined by biopsy. Because symptoms and severity vary, doctors need to develop an individual regimen to meet the specific health of each patient.

4. Treatment of lupus nephritis

Currently, there is no cure for lupus nephritis. Treatments are aimed at:
Relieve symptoms or make them go away Keep the disease from getting worse Maintain remission Avoid dialysis or a kidney transplant 4.1 Conservative treatment Overall, Doctors may prescribe treatments for people with lupus kidney disease such as:
Dietary changes: Limiting the amount of protein and salt in the diet can improve kidney function.

Blood pressure medications: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) can help control blood pressure. These drugs also prevent protein from leaking from the kidneys into the urine. Diuretics can help you get rid of excess fluid. However, conservative treatment alone is not effective for lupus nephritis. Therefore, patients need to perform more combined treatment measures.

4.2 Immunosuppressive drugs For people with severe lupus nephritis, the patient is prescribed medication that slows or stops the immune system from attacking healthy cells, such as:
Steroids, such as prednisone Cyclosporine Tacrolimus Cyclophosphamide Azathioprine (Imuran) Mycophenolate (CellCept) Rituximab (Rituxan) 4.3 Treatment of kidney failure For people who have progressed to kidney failure, treatment options include:
Dialysis: Dialysis helps remove fluids and wastes out of the body, maintain the balance of electrolytes in the blood, and control blood pressure by filtering the blood through a hemodialysis machine. Kidney transplant: The patient receives a new kidney from a donor if the patient's kidneys can no longer function. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment.
To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.
References: webmd.com, lupus.org, mayoclinic.org