Lupus nephritis - Causes, Symptoms and Treatment .MF .
Lupus nephritis - a kidney disease in systemic lupus erythematosus.Systemic Lupus Erythematosus - is a disease associated with a defect in the immune system, which is accompanied by the formation of autoantibodies specific proteins that interact with a variety of body tissues, leading to the development of inflammation.Inflammation is formed in the skin, joints, heart, lungs, but the most life-threatening kidney disease, and is the central nervous system.It is established that develops nephritis in 50-70% of cases.Women suffer from systemic lupus erythematosus is nine times more often than men.
Causes of lupus nephritis
The exact cause of the disease has not been established.But there is a number of factors, which may serve as a trigger the development of systemic lupus erythematosus.These include:
• Genetic predisposition.It was found that lupus occurs more frequently in individuals with a specific genotype, as well as in cases of close relatives.Also, there is a relationship of the disease with t
• Female sex hormones, especially estrogen.They are able to suppress the immune system defenses, and under certain conditions may contribute to the development of the disease.In fact, the disease is prevalent in women of childbearing age.Often there is a manifestation of the disease during pregnancy.Recently, in connection with the appointment estrogensoderjath drugs, menopause, described cases of systemic lupus erythematosus in menopausal women.
• The most important environmental factors include ultraviolet radiation.Many patients point to the emergence of the disease after a prolonged sun exposure.It is believed that damage to skin by ultraviolet rays contributes to the activation of the immune system and the development of immune inflammation.
• The essential role played by taking certain drugs (isoniazid, methyldopa) in the development of the disease as well as infectious diseases.Under the action
predisposing factors are activated immune cells (B lymphocytes), which is accompanied by production of large quantities of antibodies to different proteins of the organism.When their immune complexes formed by interaction.The immune complexes cause damage to body tissues with inflammation development.Localization of inflammation in the body or that determines the symptoms of the disease.
especially important for the development of lupus nephritis is the formation of antibodies to double-stranded DNA kidney cells.As a result of the body to defend themselves against pathological proteins that activate the immune system a number of mechanisms, which destroy the cells containing immune complexes.This leads to disruption of organ function.
Symptoms of lupus nephritis
external manifestations of the disease are varied and consist of the common signs and symptoms specific for systemic lupus erythematosus.
• Increased body temperature, sometimes to high numbers.
• Skin lesions: erythema (red coloration of the skin due to the expansion of the subcutaneous capillaries) on the face in the form of a butterfly, rashes are also possible at other sites.
Skin erythema in systemic lupus erythematosus.
• The defeat of the joints: arthritis, usually of small joints.
• vascular lesions: capillary (inflammation of the small blood vessels), the tips of the fingers, palms and soles less.
capillaries in systemic lupus erythematosus.
• Defeat Lung: fibrosing alveolitis (widespread damage lung tissue, followed by scarring), pleurisy (inflammation of the pleura).
• Cardiac involvement: myocarditis (inflammation of the tunica-infarction heart failure), endocarditis Libman-Sacks (inflammation of the lining of the heart, endocarditis), pericarditis (inflammation of the outer membrane of the heart, pericardium).
• Central nervous system: lupus cerebrovascular (brain disease associated with abnormal blood vessels).
• Renal disease: lupus nephritis.
manifestations of lupus nephritis are extremely varied and depend on the severity of the pathological process.In accordance with the severity of the stand:
• active form of jade: rapidly progressive and slowly progressing to nephrotic syndrome (a condition characterized by the release of large amounts of protein in the urine, reduction in blood protein concentration, impaired fat metabolism, development and distribution of swelling up to the clusterfluid in the body cavities: abdominal, thoracic, pericardial cavity) or severe urinary syndrome (the appearance of increased amounts of protein and blood in the urine in the absence of external manifestations of the disease);
• inactive form of jade: with minimal urinary syndrome or moderate proteinuria (. Protein in the urine Normally, protein in the urine is absent).
rapidly progressive nephritis is a life-threatening condition and is characterized by malignant course with the rapid development of renal failure.This disease is characterized by a pronounced nephrotic syndrome, haematuria (blood in the urine), the appearance of severe hypertension, which is usually difficult to treat.Often rapidly progressive nephritis occurs with DIC (critical state, which is based on a bleeding disorder).This form of lupus nephritis manifests in the first year of systemic lupus erythematosus.It was found that five-year survival in these patients, despite treatment, is only 29%.
Slowly progressive nephritis with nephrotic syndrome is characterized by the appearance of protein in the urine, hypertension.When lupus nephritis is not revealed massive proteinuria, such as in amyloidosis, and as a result, there is no marked edema syndrome.This form of the disease occurs in about 40% of cases of lupus nephritis.
Slowly progressive nephritis with severe urinary syndrome characterized by proteinuria, hematuria, in some cases, the appearance of white blood cells in the urine.As a rule, proteinuria and hematuria are rarely found in isolation.Increase in the number of white blood cells in the urine suggests joining the secondary inflammation (eg, pyelonephritis).Half of the diseased arterial hypertension also detected, but it is characterized by a milder course and usually controlled drugs.However, an increase in pressure in itself has a damaging effect on blood vessels, which also contributes to the formation of kidney failure.Therefore, an adequate control of blood pressure plays an important role in the prognosis of the disease.
Ten-year survival rate in patients with nephrotic syndrome without hypertension is 60-70%.In the presence of bladder syndrome disease the prognosis more favorable.Lupus nephritis with minimal urinary syndrome is diagnosed when the protein concentration in urine of less than 0.5 g / day, no hematuria, urinary leukocytes and hypertension.Renal function is normal or only slightly reduced.Externally detected signs of a lesion of other organs, characteristic of systemic lupus erythematosus.
diagnosis of lupus nephritis Lupus nephritis
diagnosed based on clinical and laboratory data.Typically, the disease occurs in young women under the influence of predisposing factors and manifested by fever, joint pain and skin rash, usually on the face.In laboratory analysis notes the acceleration of erythrocyte sedimentation rate, decreased white blood cell count.
disease occurs with periodic exacerbations and periods of absence of external manifestations.And, as a rule, in 1-2 months after one of these exacerbations during examination determined the protein and / or red blood cells in the urine, which characterizes the development of nephritis.
most reliable signs of the presence of systemic lupus erythematosus is the definition of LE-cells and antibodies to DNA in blood tests.Therefore, these tests are necessary in the identification of isolated proteinuria.
Treatment of lupus nephritis
Therapeutic strategy depends on the form of the disease.The drugs of choice are hormones (dexamethasone), and cytotoxic drugs (cyclosporine).Effectively their joint application.For rapidly progressive nephritis recommended pulse therapy - the use of maximum doses of medications for a short time, typically three days, with repetition of the treatment after a few months.
When ESRD as replacement therapy are shown a hemodialysis sessions.Transplant (transplant) kidney is the method of choice for the treatment of the disease, but it must be carried out only with a decrease in activity of immune inflammation.Otherwise, there is a great likelihood of damage to a kidney blood circulating immune complexes.
physician therapist, nephrologist Sirotkin EV