Lupus and your kidneys

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Lupus and your kidneys

• Dr. Heather Reich MD PhD FRCPC
• Nephrologist, Clinician Scientist
• University Health Network
• Assistant Professor, University of Toronto

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Outline

• What do your kidneys do?
• How can SLE affect your kidneys?
• Good news about SLE-related kidney disease
• What do you need to ask your doctor?
• Treatment and research

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Outline

• What do your kidneys do?
• How can SLE affect your kidneys?
• Good news about SLE-related kidney disease
• What do you need to ask your doctor?
• Treatment and research

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Up to Date 2009
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Kidney Functions

• Clean and balance
• Filter / Sieve
• Control blood pressure
• Make blood

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Outline

• What do your kidneys do?
• How can SLE affect your kidneys?
• Good news about SLE-related kidney disease
• What do you need to ask your doctor?
• Treatment and research

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How can SLE affect your kidneys?

• Nothing at all or abnormal dipstick
• Medications anti-inflammatories
• Lupus Nephritis
• Other (APLA)not discuss today

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www.jimstanis.com
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Jennette Online Path Atlas
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How can SLE affect your kidneys?

• Lupus Nephritis
• Classified according to the biopsy appearance
• World Health Organization scheme
• ISN/RPS I-VI
• 3 main categories
• Inflammation/proliferation most common
• Membranous clogging of the filter
• Scar
• Mixture

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Jennette Online Path Atlas
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What are the chances of your kidneys being
affected by SLE?

• Depends on how you define involved
• Common
• Abnormal urine test
• Less common
• lupus nephritis around 25
• High blood pressure
• Rare
• Kidney failure (dialysis, transplant) ..

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Outline

• What do your kidneys do?
• How can SLE affect your kidneys?
• Good news about SLE-related kidney disease
• What do you need to ask your doctor?
• Treatment and research

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Good news about SLE-related kidney disease

• HOT OFF THE PRESSES (actually, not even in the
  presses yet it is so HOT!!!)

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Good news

• The long term course of kidney function in people
  with SLE
• LunNET University of Toronto Lupus Clinic
• 500 patients within 1 year of diagnosis of lupus
  with and without kidney disease
• Average follow-up of over 11 years

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Good news

• Overall the rate of permanent kidney failure is
  VERY LOW only about 18 of 500
• Even if you have a very bad kidney flare at
  presentation, you still have an excellent chance
  of recovery with treatment
• I suspect this is likely due to better
  medications to treat flares

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Good news

• We have identified some modifiable risks
• Protein in the urine
• High Cholesterol
• Some maybe modifiable risks
• Ongoing inflammation, incompletely treated flares

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Urine protein
Cholesterol
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Outline

• What do your kidneys do?
• How can SLE affect your kidneys?
• Good news about SLE-related kidney disease
• What do you need to ask your doctor?
• Treatment and research

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What do you need to ask

• First, what are the symptoms?
• Very few
• Swelling, frothy urine
• Cola-coloured urine
• Nausea, vomiting, itching, cramping, breathing
  difficulties.
• Other signs of flare

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What do you need to ask?

• Often first signs will be detected
• by your doctor
• Exam High blood pressure, swelling
• Lab tests
• Inflammation Urine spot test blood, cells
• Lab tests
• Cleaning Creatinine lower better, normal
  75
• Filter Urine protein 24h urine collection,
  spot screens, blood protein
• Risks Cholesterol

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Outline

• What do your kidneys do?
• How can SLE affect your kidneys?
• Good news about SLE-related kidney disease
• What do you need to ask your doctor?
• Treatment and research

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Treatment and Research

• Treatment
• Flares
• Chronic / long-term issues protein,
  cholesterol, BP, heart protection

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Treatment and research

• Treatment immune system
• Flares
• Induce remission
• Maintain remission / prevent further flares
• Common agents
• Prednisone
• Cyclophosphamide, Mycophenolate, Azathioprine
• Cyclosporine, tacrolimus

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Treatment and research

• Treatment non-immune
• Conservative
• ACE inhibitor or angiotensin receptor
  blockade
• Cholesterol statin
• Blood pressure control, diuretics for swelling
• Dialysis hopefully temporary

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Treatment and research

• What you can do
• Salt restriction
• Healthy heart diet
• Participation in monitoring
• Flu shot, immunization
• Exercise, healthy living

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Treatment and research

• Causes of lupus
• Genetics
• Environmental and infectious
• Monitoring
• Biomarkers tests that help predict who is
  going to get nephritis
• Better tests to catch nephritis early before
  symptoms or damage
• Tissue, urine, blood

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Treatment and research
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Treatment and research

• 244 Registered clinical trials
• www.clinicaltrials.gov
• B Cell CD20 a few compounds
• LUNAR flop?
• Abatacept CTLA4
• Remicade class V
• Fibrosis scarring
• Statin

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Lupus and your kidneys summary

• Kidney involvement is quite common irreversible
  kidney failure is rare
• Several patterns of kidney involvement diagnosed
  by biopsy
• Very few symptoms
• Monitoring with blood and urine tests
• Treatment
• Conservative
• Immune

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Support

• Kidney Foundation of Canada, CIHR, CSN
• LunNET
• Amgen, Canada
• PSI Foundation
• UHN Division of Rheumatology

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Reliable references

• www.clinicaltrials.gov
• www.lupuscanada.org
• www.kidney.ca
• www.kidney.niddk.nih.gov