Title: Understanding Lupus Nephritis: A Comprehensive Guide for Modern Family Doctors
Overview:
Lupus nephritis (LN) is a kidney disorder that occurs in individuals with systemic lupus erythematosus (SLE), a chronic autoimmune disease affecting multiple systems. This article provides a comprehensive overview of lupus nephritis, including its diagnosis, treatment, and prevention, tailored for modern family doctors.
Understanding Lupus Nephritis:
Lupus nephritis (LN) is a kidney complication of systemic lupus erythematosus (SLE), a chronic systemic autoimmune disease characterized by multiple organ damage. It is a common autoimmune disease in China, predominantly affecting women of childbearing age. Over 50% of SLE patients exhibit kidney damage, with renal biopsy showing almost universal kidney involvement. Renal failure is a common cause of death in SLE patients.
Diagnosis:
The diagnosis of lupus nephritis involves a combination of clinical symptoms and laboratory tests. Common kidney manifestations include asymptomatic proteinuria and/or hematuria, hypertension, nephrotic syndrome, acute glomerulonephritis, and rapidly progressive glomerulonephritis. Proteinuria is the most common symptom, with about 25% of patients developing nephrotic syndrome. Other renal manifestations include microscopic hematuria, leukocyte casts, and gross hematuria.
Renal extrinsic symptoms include fever, fatigue, general malaise, anorexia, and weight loss. Cutaneous manifestations include butterfly rash on the face, discoid rash, oral ulcers, photosensitive alopecia, Raynaud's phenomenon, reticular macules, and pernio. Neurological symptoms include persistent migraines, personality changes, cognitive impairment, chorea, neuropathy, cerebrovascular accidents, coma, and seizures. Musculoskeletal symptoms include abdominal pain, muscle weakness, myositis, arthritis, and joint pain. Cardiovascular, pulmonary, and gastrointestinal involvement may cause xerostomia, dry eyes, retinal vasculitis, and recurrent miscarriage.
Laboratory tests for diagnosis include complete blood count, urinalysis, stool analysis, 24-hour urine protein, electrolytes, liver and kidney function tests, blood lipids, myocardial enzymes, erythrocyte sedimentation rate, rheumatoid factor, serum complement C3 and C4, antinuclear antibody, anti-dsDNA antibody, ENA peptide profile, and hepatitis B surface antigen tests. Additional tests include electrocardiogram, chest X-ray, renal ultrasound, antineutrophil cytoplasmic antibody, antiphospholipid antibody, lupus cells, echocardiogram, cranial CT, and renal biopsy.
Lupus nephritis should be differentiated from primary glomerular diseases, Henoch-Schönlein purpura nephritis, primary vasculitis renal damage, gouty nephropathy, rheumatoid arthritis damage, Sjögren's syndrome damage, and overlapping syndrome renal damage.
Treatment:
Treatment of lupus nephritis involves general management, medication, and alternative treatments.
General Management: Patients with active disease should rest, avoid excessive sun exposure, and receive appropriate antibiotic therapy for infections. Avoid medications such as procainamide, phenytoin, and hydralazine.
Medication: Treatment varies depending on the pathological type of LN. Patients with type I and mild type II LN may not require specific treatment, but they should receive symptomatic treatment and control renal extrinsic lupus lesions. Severe type II and type III LN with no significant histological lesion activity can continue to receive symptomatic treatment or low-dose corticosteroids, such as prednisone at 0.5 mg/kg/day. If the response to corticosteroids is poor or there are contraindications, cyclophosphamide can be used. Membranous lupus nephritis (type V) can be treated with symptomatic treatment and control of renal extrinsic manifestations. Nephrotic syndrome requires high-dose corticosteroids (e.g., prednisone at 1 mg/kg/day) combined with cyclophosphamide and azathioprine. Tacrolimus and sirolimus can also be used for membranous lupus nephritis but should be used with caution due to their nephrotoxicity.
Alternative Treatments: For end-stage renal failure (e.g., renal atrophy), renal replacement therapy, such as hemodialysis or kidney transplantation, may be necessary.
Prevention:
To prevent lupus nephritis, it is important to avoid infections, use non-nephrotoxic medications for colds under medical guidance, avoid excessive sun exposure, prevent overexertion, ensure adequate sleep, maintain a positive mood, and overcome negative mental states. Use corticosteroids and other related medications correctly, do not discontinue or reduce medication without medical advice, closely follow up with the doctor, and adjust medication under medical guidance to prevent recurrence and ensure the best treatment outcomes.
Conclusion:
Lupus nephritis is a complex disease that requires a comprehensive approach to diagnosis, treatment, and prevention. Modern family doctors play a crucial role in managing this condition and ensuring the best possible outcomes for patients.