My understanding of Systematic Lupus Erythematosus and Lupus Nephritis

Living with Lupus is a journey and part of this is to always learn, to be in the know and raise awareness. I have found a number of resources that have been helpful in improving my understanding of the SLE and its impact.

 

This is by no means medical advice and should not in any way be substituted for medical advice. I have literally just tried to summarise the condition, specific to my experiences and how it has affected me. 

 

Systemic Lupus Erythematosus (SLE) is an autoimmune disease where the immune system attacks healthy tissue - it becomes overactive. Because it can attack anywhere in the body, its symptoms are quite diverse and it is also known to mimic other physical health conditions. 

"During one of my days in the Lupus clinic, I met a Turkish lady in her early 20's who was diagnosed at the age of 13. She had a rash common in lupus patients called butterfly rash (normally appears on the face around the nose and cheeks).  For me, I had joint pains especially in my knees with the first flare when I was in year 9 or 10- which at the time was treated as a one-time occurrence and was only linked to SLE many years later". 

Lupus is most common in females than males, it is also common in people of African and Asian origins and can be diagnosed at different ages. It is thought that genetic and environmental factors, can put people at risk of developing lupus.

"There was no family history of anything of this kind. And to make things harder we no one in my family knew what lupus was- apart from my husband".

With Lupus, the immune system can attack the skin, joints, heart, brain, lungs and kidneys. 

 

There are four types of this condition:

  • Cutaneous lupus (including discoid lupus) 

  • 'Systematic' Lupus Erythematosus  (SLE) 

  • Drug-induced Lupus

  • Neonatal Lupus

 

Lupus Nephritis is a form of SLE where the immune system's overactivity scars or causes swelling of the part of the kidneys that filter the blood. These vessels (glomeruli) scar and swell at varying degrees- also leading to the classifications of the condition (please see table below).

"I was told that I had Class V Lupus Nephritis- Membranous Glomerulonephritis. Basically more than 50% of my glomeruli had been scared. This was the chronic type hence the Chronic Kidney Disease (CKD) aspect of my diagnosis".

I read up about it and again and again thanking God that my case was not as the condition dictates. 

Abbreviated International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis (2003)

Class I - Minimal mesangial lupus nephritis

Class II - Mesangial proliferative lupus nephritis

Class III - Focal lupus nephritis

Class IV- Diffuse segmental or global lupus nephritis

Class V - Membranous lupus nephritis

Class VI -Advanced sclerosing lupus nephritis

There are two types of Gulmerolonephritis- acute and chronic and but come with their symptoms.

Acute:

  • puffy face  

  • hematuria- blood in the urine

  • reduced frequency of urinating 

Chronic:

  • Hematuria or proteinuria (protein in the urine)

  • High blood pressure

  • Oedema- the build-up of excess water in ankles or face

  • Increased frequency of urinating (especially at night

  • Frothy or bubbly urine

Infections and other conditions are possible causes for the acute kind. Regarding the chronic type, genetics, changes to the immune system activity as well as the development of the acute form over time can result in the chronicity of the condition. 

Please read more on this from The National Kidney Foundation.

You may also find the following sites helpful

"I had to have a kidney and bone marrow biopsy before the extent of the condition and impact on my kidney function could be established." 

References and Resources

Make Lupus Visible image (2020). Available at: https://www.instagram.com/p/B3MIZruD972/ (Accessed: 11 September 2020).

Weening, J. et al. (2004) "The classification of glomerulonephritis in systemic lupus erythematosus revisited", Kidney International, 65(2), pp. 521-530. doi: 10.1111/j.1523-1755.2004.00443.x.

What is Glomerulonephritis? (2015). Available at: https://www.kidney.org/atoz/content/glomerul (Accessed: 13 September 2020).

What is lupus? (2020). Available at: https://www.lupus.org/resources/what-is-lupus (Accessed: 13 September 2020).

What is Lupus? (2020). Available at: https://www.lupusuk.org.uk/what-is-lupus/ (Accessed: 13 September 2020).

What is Lupus — Lupus Trust - A Guy’s and St Thomas’ Charity (UK) (2020). Available at: https://www.lupus.org.uk/what-is-lupus (Accessed: 13 September 2020).

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