Cape Town – During the month of May, the Western Cape Department of Health and Wellness is raising awareness of lupus, a condition which causes a limitation of daily activities.
Lupus, technically known as “systemic lupus erythematosus (SLE)”, is an autoimmune disease that causes inflammation in various parts of the body.
Inflammation caused by lupus can affect almost any part of the body systems, including the skin, heart, lungs, joints, blood vessels, brain and the kidneys.
Lupus Nephritis (LN) is one of the most serious complications of SLE where the immune system mistakenly attacks healthy tissues and organs.
During 2023, Tygerberg Hospital treated 427 outpatients with LN. With this condition, the kidneys become inflamed, leading to potential kidney damage and impaired kidney function.
Understanding LN is crucial for patients with SLE to manage their condition effectively and maintain kidney health.
In keeping with this year’s theme “Beyond Lupus”, Dr Riette du Toit, head of the division of rheumatology at Tygerberg Hospital, explained that the exact cause of LN is not fully understood but it is believed to result from a combination of genetic, environmental, and hormonal factors.
“In a South African study, LN was found to be the most common identifiable cause of glomerulonephritis – a specific form of kidney disease diagnosed through kidney biopsy.
“LN was detected in 39% of kidney biopsy cases and was more common than HIV (22%) and diabetic-associated kidney disease (14%), an indication that this is not a rare disease in our population,” Du Toit said.
“Patients of African origin, as well as mixed racial ancestry, tend to have more aggressive disease than Caucasian patients, again emphasising the importance of screening and early detection of kidney involvement in our population,” she added.
Beulah September, aged 58, from Elsies River, was diagnosed with lupus in 2003, at the age of 37.
“I was initially referred by a private doctor that said the Rheuma Clinic at Tygerberg Hospital was excellent. In 2010, just as I was in remission with lupus, I was also diagnosed with kidney failure. Shortly in 2013, we discovered that lupus also weakened my heart.”
LN may not always cause noticeable symptoms in the early stages. As the condition progresses, patients may experience swelling (oedema) in the legs, ankles, feet or around the eye, weight gain due to fluid retention and high blood pressure.
Other non-specific signs frequently seen in SLE includes fatigue and weakness, and loss of appetite.
It's essential to recognise these symptoms and seek medical attention promptly if you experience any of them, as early diagnosis and treatment can help prevent further kidney damage.
To recognise the disease in its earliest stages, healthcare practitioners can screen for the kidney disease through a urine dipstick, looking for leaking of protein into the urine.
“The diagnosis of LN typically involves a combination of urine tests, blood tests and a kidney biopsy,” Du Toit advises further.
“The biopsy is necessary to confirm the diagnosis and determine the specific class of LN, the extent and severity of kidney damage. This will guide the doctor with regards to the most appropriate treatment.”
Treatment for LN aims to control inflammation, preserve kidney function and prevent complications. Treatment decisions is usually made by a nephrologist (kidney specialist), in conjunction with a rheumatologist (lupus specialist).
Treatment options may include:
- Medications to suppress the immune system and reduce inflammation and damage (eg corticosteroids, cyclophosphamide, mycophenolate mofetil or rituximab);
- Antihypertensive medications to lower blood pressure and protect the kidneys; and,
- Diuretics to help reduce fluid retention.
Immunosuppressive treatment is usually taken for a prolonged period (up to five years) to ensure that the disease remains controlled. Taking medication regularly as prescribed is essential to ensure a good outcome.
Lifestyle modifications, including a balanced diet, regular exercise, avoiding smoking and excessive alcohol consumption, are also necessary.
Regular monitoring and follow-up with a rheumatologist or nephrologist experienced in managing LN are essential to monitor kidney function, adjust treatment as needed and prevent disease progression.
“Develop a good attitude and stay positive even if you don’t feel like it. Become part of a group of people that come to help you stay positive and support you on your journey with lupus,” September added.
“LN is a serious complication of SLE that requires early diagnosis, prompt treatment and ongoing management to preserve kidney function and improve quality of life,” Dr du Toit said.
“By understanding LN, staying proactive in your care and working closely with your healthcare team, you can take control of your health and effectively manage this condition.”