Not Looking Good for Lupus and Kidney Patients

Increased rates of end-stage renal disease caused by lupus

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) According to findings from two new studies, kidney failure is affecting more and more young people and African Americans. In addition, there hasn't been much improvement in the end results for these patients, especially for children with kidney failure caused by a type of lupus.

Even with the development of new treatments, these patients are not experiencing better outcomes. In more than 10 years of study, researchers did not see any improvement in rates of death.

dailyRx Insight: Doctors are still searching for lupus nephritis related kidney therapies.

Drawing information from the U.S. Renal Data System, Karen Costenbader, M.D., M.P.H., from Brigham and Women's Hospital, and colleagues examined the amount of new diagnoses and outcomes of people with end-stage renal disease caused by lupus nephritis.

For their first study, researchers looked at more than 12,300 cases of kidney failure due to lupus nephritis. In addition to seeing increased rates of the disease among patients between five and 39 years of age, the researchers found that African Americans were six to seven times more likely than white patients to fall victim to kidney failure from lupus nephritis.

For the second study, which looked specifically at children, the researchers analyzed 583 cases of kidney failure caused by lupus nephritis. They found that within five years of being diagnosed with end-stage renal disease, almost half of children were put on a wait list for kidney transplant. About one-third of these children received a kidney transplant, while 22 percent died.

According to Dr. Costenbader, the challenge of taking care of these patients is underlined by the changing demographic of those affected and the poor outcomes they experience. More research needs to be done, she adds, to figure out risk factors and treatments for end-stage renal disease caused by lupus nephritis.

Close to 200,000 people in the United States have lupus, with women being affected nine times more than men. Lupus is an autoimmune disease that attacks multiple organ systems and connective tissues in the body. It is incurable, but treatable, and most people with lupus will live a normal lifespan. Women of Afro-Caribbean descent are affected three times more often than other groups. The initial symptoms of lupus are fever, joint pains and fatigue. About 30% of lupus patients have dermatologic symptoms, with 30%-50% getting the characteristic butterfly shaped rash on the face. Another very serious complication is end stage renal disease (ESRD), and kidney transplants are common. There is no single genetic cause for lupus, but many different genes have been identified as contributors to developing lupus. The most important genes for lupus development are located in the chromosome 6 HLA region. Lupus can also be drug induced by quinidine, phenytoin (Dilantin), hydralazine (Apresoline), and procainamide (Pronestyl), but is fortunately reversible. Drugs used to treat lupus are frequently DMARDS (disease modifying antirheumatic drugs) such as Humira, Rituxan, Remicade, methotrexate, and Enbrel. Steroids and other immunosuppressants help reduce symptoms as well (Belimumab, Atacicept). Painkillers, such as Vicodin or Darvocet are common and often necessary. An ANA (antinuclear antibody) blood test can be used to diagnosis lupus.

Chronic kidney disease affects over 26 million people in the United States, with more being affected by instances of acute kidney disease. Kidney disease results when the kidneys gradually lose their ability to filter out waste products from the blood and maintain the proper balance of water, salts and proteins in the blood. Chronic kidney failure can be caused by a multitude of reasons, but is commonly seen in patients with high blood pressure and diabetes, as well as patients with autoimmune diseases. Acute kidney failure is similar to chronic kidney failure in that the kidneys fail to do their jobs, but it happens at a more rapid pace, usually due to loss of blood flow, toxic drugs, or obstruction of urine flow. Symptoms of kidney failure include feeling tired, muscle cramps, trouble sleeping, swollen feet and puffy eyes, and an increased need to urinate. Eventually many patients need replacement of the hormones erythropoietin and calcitriol, and sometimes dialysis and kidney transplantation Treatment includes medications like ACE inhibitors (Lotensin, Capoten, Vasotec) and ARBs (Cozaar, Diovan, Benicar) although they are not curative.. Diagnosis is made by measuring substances in the blood and urine.

Both studies are published online in Arthritis & Rheumatism

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Review Date: 
March 28, 2011
Last Updated:
March 29, 2011