Lupus and CKD: What is their relationship?

Chronic kidney disease and this autoimmune condition may be closely related.

To start talking about lupus (SLE, systemic lupus erythematosus, by its full name) and its connection to CKD, we will start by reviewing what it is. This disease is recognized by the body generating antibodies (in charge of inactivating foreign bodies) but in this case, attacking the patient's tissues (autoantibodies).

Body tissues can be widely affected in a case of lupus, both in a mild form (skin and joints) and in most organ forms, such as the kidney.

Kidney involvement is known as the generic term lupus nephritis, where autoantibodies affect different kidney structures, causing inflammation of varying intensity.

Lupus nephritis is most common among people between the ages of 20 and 40. It can occur during the first five years after a diagnosis of severe lupus, according to the Lupus Foundation of America.

The Lupus Foundation of America also estimates that, over time, up to 60% of lupus patients could develop lupus nephritis. In the case of children with lupus, the percentage increases to almost 70%, as two-thirds of patients could develop it.

Consequently, having clear symptoms can help patients with lupus to detect in time if their kidneys are compromised.

Common symptoms:
• Erythema (rash, rash in the facial region).
• Hair loss.
• Swelling.
• Ulcers on the oral mucosa.
• Arthritis in more than two joints

• Inflammations of the pleura and/or pericardium (membranes that surround the lungs and heart, respectively).
• Anemia.
• Decrease in white blood cells.
• Changes in urine habits (urinating more often at night).
• Renal involvement (lupus glomerulonephritis).

The last symptom is clinically expressed by haematuria (blood in the urine), proteinuria (loss of protein through the urine), possible arterial hypertension, impairments of glomerular filtration (increased levels of ureic nitrogen or creatinine) and other alterations that, with a urine, blood or biopsy examination, allow us to determine if the structures of the kidney are being affected, as explained by Rafael Mauricio Sanabria, a specialist in Internal Medicine and Nephrology and manager of Medical and Scientific Affairs at Baxter Renal Care Services.

The advantages of an early diagnosis of CKD in case
of lupus

In the presence of this type of symptoms or a confirmed diagnosis of SLE, the patient should consult the specialist doctor to implement diagnostic and treatment measures early to prevent the disease from progressing and can significantly affect the kidneys or other organs.

"With advances in diagnosis and treatment, the prognosis of SLE is generally good with excellent 10-year survival rates, so that it is currently considered a chronic autoimmune disease with very good tools for its treatment," explains Dr. Sanabria.

I was diagnosed with CKD, where to start?

For most patients, this clinical condition is a gateway to a new world of variants and terminology that could be difficult to understand. For this reason, we want to point out some critical aspects about the comprehensive care of this population.

The first thing we must do is lose the fear of the word chronic disease. As explained by Juan Carlos Alarcón Internist and Nephrologist, Clinical Operations Manager of Baxter RCS, we must begin by understanding that a chronic disease is basically one "that belongs to a group of long-term diseases and whose evolution is generally slow". That is, it is a disease with which we will have to learn to live, understanding that it is a condition to which we will have to devote attention and care.

We also need to understand that there is a big difference between having Kidney Failure and having chronic kidney disease. In fact, as our guest nephrologist recalls, only a small percentage of patients with chronic kidney disease will require replacement treatment and another percentage of patients (with Chronic Renal Failure in Replacement Therapy or without it), will require palliative care.

Changes in my lifestyle: Understanding the stages of CKD (chronic kidney disease).

The first thing they explain to us as CKD patients is that the condition is divided into several stages. Some of them have to do with our pre-existing conditions (diabetes, hypertension, smoking and obesity, among others), or with factors not dependent on our style or habit of life such as the kidney's own (primary) diseases.

Understanding which of the five stages we are in, we can (together with the clinical team) proceed to slow down, if possible, the rate of progression of CKD and the following are very general concepts.

There are five stages. Since the diagnosis of Chronic Kidney Disease (regardless of its stage), Medical accompaniment is required in which indications of care must be followed to prevent or delay progression to more advanced stages of the disease where renal replacement therapy (dialysis and/or transplantation) or palliative care is necessary.

1. First stage: Renal function (in performance issues) is normal, but there may be conditions that affect this function in the future. At this stage, it is essential to make lifestyle changes and/or specific treatments according to the underlying disease.

2. Second stage: In this stage, renal function is still stable. As in the previous stage, general health care is essential and according to the condition (for example, presence of protein or blood loss in the urine), specialized medical follow-up is essential to perform an early intervention and thus avoid (when possible), loss of kidney function.

3. Third stage: In this stage, there is already a functional alteration (independent of age). Concomitant conditions such as chronic anaemia, bone disease, inflammation, difficult to manage arterial hypertension, edema (swelling), alteration in blood glucose levels, among others, may occur.

4. Fourth stage: In this stage and according to the speed of loss of renal function, and with an appropriate process of shared decisions, the patient, his family and/or caregiver should prepare for the possibility of renal replacement therapy (such as peritoneal dialysis or haemodialysis, renal transplantation, or palliative care).

5. Fifth stage: After the preceding preparation, patients should already be aware of the therapeutic options and under the concept of the best quality of life according to their expectations, and preferences, make the best decision of Renal Replacement Therapy.

Some changes I will have to make

The Nephrologist who accompanies us also suggests specific changes that we will have to implement to avoid the progression of the stages explained above.  

1. Blood pressure control: Not only does it decrease the chance of any brain-cardiovascular event. Also, it can potentially slow the rate of progression (deterioration) of kidney function.

2.  Glycaemic control: In diabetic patients, there is convincing literature that shows that adequate glycaemic control is a key factor either to avoid CKD or to slow its rate of progression. In elderly patients at high risk of hypoglycaemia, the goals may be different from the general population.

3. Likewise, it has been demonstrated in observational studies how smoking is directly associated not only with a higher incidence (presentation) of CKD, but with a greater speed of progression in patients with the disease.

4. In patients with established CKD, the control of protein intake has shown, in both diabetic and non-diabetic patients, a decrease in the rate of progression of CKD, if this control is provided by a specialist in the subject.

5. Depending on the patient's condition and kidney function, the use of medications becomes a fundamental tool, not only to slow their rate of progression, but also to minimize the possibility of related conditions that may impact health outcomes. In summary, there are drugs that impact not only the appearance of CKD, but also its progression, but they must be prescribed by medical personnel.

A matter of attitude and mentality

Although we are facing with a condition that requires our care and special attention, it is important to remember that our attitude, willingness, and good spirits in the face of adversity are more important than ever. Likewise, we must surround ourselves with family and/or caregivers who nurture this spirit of optimism and care.

"In the era of Patient-Related Outcomes and Person-Centered Care, it is fundamental and critical to care for the well-being of the patient, family and caregiver and, in any case, to carry out an adequate decision-making process."