Lupus nephritis causes kidney inflammation and can often lead to chronic kidney disease (CKD). An issue that medical professionals have faced is predicting the likelihood of individual patients developing CKD. According to Healio, researchers have found that a lack of EULAR/ERA-EDTA lupus response acts as a predictive endpoint.
About Lupus Nephritis
Lupus nephritis is a complication from lupus that causes kidney inflammation. Antibodies attack the part of the kidneys that filter out waste, causing proteinuria, inflammation, hematuria, high blood pressure, and kidney failure in extreme cases. Females and those of African and Asian descent are at a higher risk of developing lupus.
Symptoms specific to lupus nephritis include pain and swelling in the joints, dark and foamy urine, edema, high blood pressure, muscle pain, fever, and rash. The cause is unknown, although medical professionals suspect that it is a combination of genetic and environmental factors. Various lab tests, including urine tests, blood tests, and a kidney biopsy, are used to diagnose this condition. Treatment aims to decrease inflammation, reduce high blood pressure, and suppress the immune system.
About Chronic Kidney Disease
Chronic kidney disease (CKD) occurs when there is damage in the kidneys that progresses over time. About 26 million adults in the United States are affected by CKD. It is often the result of another condition, such as diabetes, high blood pressure, and polycystic kidney disease among others. Patients will experience the symptoms of their first disorder along with the effects of CKD, which include jaundice, stunted growth, high blood pressure, an enlarged liver or spleen, nausea, lack of appetite, vitamin deficiencies, fatigue, sleep issues, weakness, muscle cramps and twitches, changes in urination, persistent itching, shortness of breath, and swelling in the feet and ankles. Treatment is symptomatic and focuses on reducing complications and slowing progression. Doctors may prescribe diuretics, high blood pressure medication, cholesterol medication, anemia medication, and supplements to protect the bones. If CKD progresses enough, dialysis and kidney transplants may be necessary.
Predicting CKD
Medical professionals have found that the EULAR/European Renal Association – European Dialysis and Transplant Association response is a good set of criteria for predicting the progression of lupus nephritis to CKD. This criteria was created after reviewing medical literature and expert opinion on kidney response to therapy.
A study was conducted to test this criteria, in which 381 lupus nephritis patients were followed from the beginning of 1970 to the end of 2016. All participants underwent induction therapy and a renal biopsy, and they were all followed for over a year. Researchers were looking for a response of 0.5 grams of proteinuria and normal or near normal glomerular filtration rate.
Using the criteria, 58% of participants achieved a full response, while 16% experienced no response. After a median of 10.7 years, researchers followed up again and found that 58 participants developed chronic kidney disease. Through an assessment of their data, they discovered that no response after one year of treatment, persistent arterial hypertension, and low C4 were able to predict CKD.
It is this data that encourages the use of the EULAR/ERA-EDTA criteria to predict chronic kidney disease. Using these predictions, doctors will be able to better diagnose and treat their patients.
