How to Prevent Further Deterioration of Lupus Nephritis

2018-10-03 15:00

How to Prevent Further Deterioration of Lupus NephritisLupus Nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE) with high mortality and poor long-term prognosis. Early detection and treatment can significantly improve renal outcome. How to prevent further deterioration of Lupus Nephritis?

Symptoms of Lupus Nephritis

Patients with active LN are often associated with other SLE symptoms such as fatigue, fever, rash, arthritis, serositis, or central nervous system (CNS) disease, which are commonly seen in focal hypertrophic and diffuse hypertrophic LN.

Some patients may show asymptomatic LN, but at regular follow-up, elevated serum creatinine, low albumin or urinary protein, or sedimentation, suggest active LN. This is usually seen in typical mesangial proliferative or membranous LN.

Symptoms associated with active nephritis include peripheral edema caused by hypertension or hypoalbuminemia. Severe peripheral edema is common in patients with diffuse or membranous LN.

Other symptoms of diffuse LN include headache, dizziness, visual impairment and cardiac decompensation.

How to prevent further deterioration of Lupus Nephritis?

1. Regular examination of urine routine. Patients with systemic lupus erythematosus are highly suspected of having lupus nephritis if they have persistent proteinuria or hematuria.

Patients with lupus nephritis have different clinical manifestations. Early stage patients can have simple hematuria or simple proteinuria, and if this condition persists, nephritis should be suspected. Sometimes you should pay attention to proteinuria or hematuria of false positive, for example, urinary contamination or urinary tract infection. After the exclusion of these conditions, nephritis can be diagnosed.

2. To do kidney biopsy if required. The role of renal biopsy is to ensure the pathological type of nephritis so as to guide the treatment and determine the prognosis. Renal biopsy is not required in patients with mild lupus nephritis (24-hour proteinuria is less than 0.5-1 g), which is rapidly relieved after conventional treatment.

However, when accompanied with obvious proteinuria and hematuria, renal dysfunction, and poor treatment effect, it is better to have a renal biopsy, if possible, to facilitate doctors' judgment and treatment.

3. To follow the doctor's advice and stick to treatment. Many factors affect the prognosis of lupus nephritis. In general, type Ⅰ and Ⅱ patients have a good prognosis, unless the pathology changes. Proliferation lesions only involve few type Ⅲ glomeruli, and the incidence of EDRD in 5 years is less than 5%. Glomerular necrotic lesions or crescent Ⅲ type is similar to IV (A).

Most think type Ⅳ Lupus nephritis has a poor prognosis. Type Ⅴ has declined kidney function slowly. 5 years and 10 years of renal survival rate is 96.1% and 92.7% respectively. But above all, the prognosis must take into account the factors of treatment - adherence to treatment and selection of the most appropriate treatment. Therefore, to prevent the further deterioration of lupus nephritis, patients should actively follow the doctor's advice and cooperate with doctors to figure out the most appropriate treatment plan, and sticking to the treatment is the foundation to avoid the further deterioration of lupus nephritis.

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