Alvin Wells, MD, PhD: Let me begin by giving an outline of systemic lupus erythematosus [SLE] and lupus nephritis. If you ask any rheumatologist for a paradigm or hallmark of an autoimmune illness, it’s lupus. I make the analogy that lupus comes from the Latin phrase for wolf. What does that imply? Patients with lupus get a rash on their face that appears like a wolf or a German Shepherd. It’s troublesome to clarify what triggers it in some sufferers. If we work out the trigger, that will be a Nobel Prize.

With lupus, indignant cells are within the bloodstream. In some sufferers, these indignant cells spill out of the bloodstream, get into the scalp, and trigger alopecia, or hair loss. They get into the pores and skin, inflicting a rash. But in some sufferers, they will go internally. When they have an effect on the inner organs, that’s after we speak about aggressive remedy. It can have an effect on the lungs and coronary heart. Now we start to deal with treating lupus nephritis.

What is lupus nephritis? Imagine that the kidneys are functioning like a dam. Certain issues shouldn’t leak by the kidneys. With lupus, these indignant cells assault kidney cells, and people cells turn into free and leaky. We start to see issues that we shouldn’t see within the urine. I inform sufferers that lupus is a trademark of an autoimmune illness. It can have an effect on the pores and skin, scalp, mouth, and different areas. But it might probably additionally have an effect on inside organs, together with the kidneys, which we title lupus nephritis.

What sorts of sufferers can we see with lupus nephritis? The imply age of sufferers with lupus is 30 years outdated. That means half the sufferers are youthful, and half are older. For a lot of causes, feminine sufferers are extra susceptible to getting lupus. They can have multiply elevated threat of getting lupus in contrast with their male counterparts.

What does a affected person with lupus nephritis appear like? It’s going to be a younger affected person, primarily ladies, and now we see the influence that it has on sufferers of colour: sufferers who’re African American, Asian American, or Native American. Caucasians can get it as effectively, however these different populations are at greater threat of getting it. When these sufferers current with lupus nephritis, they’ve extra aggressive illness. I all the time inform my sufferers that I consider in aggressive remedy as a result of a few of these sufferers can get end-stage renal illness, which means the kidneys aren’t functioning as they need to, after which these sufferers sadly must go on to dialysis. That’s what lupus nephritis seems to be like.

If you concentrate on sufferers with lupus and lupus nephritis, fortunately lupus nephritis is uncommon. But I’ll use an analogy. If 3 sufferers with lupus stroll into my clinic and I haven’t seen any of them, executed a prognosis, or given any remedy, 1 could have lupus nephritis at prognosis. That implies that after I do the blood take a look at, I’ll see abnormalities that correlate with kidney illness. Then after we look contained in the urine, we are able to see protein and blood cells within the urine—issues that shouldn’t be there usually that we see in sufferers with lupus nephritis.

One of three sufferers with lupus will get lupus nephritis, and a few sufferers who don’t have lupus nephritis at baseline can develop it over a interval of years. This is why I stress that even sufferers who’ve lupus however don’t have lupus nephritis at baseline nonetheless have to be evaluated. I see my sufferers like clockwork each 3 months to verify sufferers who’re steady right this moment aren’t going to have change of their urine that’s going to be an indicator of lupus nephritis 6 months or a yr from now.

Transcript edited for readability.

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