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Overview of Systemic Lupus Erythematosus (SLE) and Lupus Nephritis (LN)


Alvin Wells, MD, PhD, opens a discussion surrounding systemic lupus erythematosus (SLE) and lupus nephritis (LN).

Alvin Wells, MD, PhD: Let me start by giving an overview of systemic lupus erythematosus [SLE] and lupus nephritis. If you ask any rheumatologist for a paradigm or hallmark of an autoimmune disease, it’s lupus. I make the analogy that lupus comes from the Latin word for wolf. What does that mean? Patients with lupus get a rash on their face that looks like a wolf or a German Shepherd. It’s difficult to explain what triggers it in some patients. If we figure out the cause, that would be a Nobel Prize.

With lupus, angry cells are in the bloodstream. In some patients, those angry cells spill out of the bloodstream, get into the scalp, and cause alopecia, or hair loss. They get into the skin, causing a rash. But in some patients, they can go internally. When they affect the internal organs, that’s when we talk about aggressive treatment. It can affect the lungs and heart. Now we begin to focus on treating lupus nephritis.

What is lupus nephritis? Imagine that the kidneys are functioning like a dam. Certain things shouldn’t leak through the kidneys. With lupus, those angry cells attack kidney cells, and those cells become loose and leaky. We begin to see things that we shouldn’t see in the urine. I tell patients that lupus is a hallmark of an autoimmune disease. It can affect the skin, scalp, mouth, and other areas. But it can also affect internal organs, including the kidneys, which we title lupus nephritis.

What types of patients do we see with lupus nephritis? The mean age of patients with lupus is 30 years old. That means half the patients are younger, and half are older. For a number of reasons, female patients are more prone to getting lupus. They can have multiply increased risk of getting lupus compared with their male counterparts.

What does a patient with lupus nephritis look like? It’s going to be a young patient, primarily women, and now we see the impact that it has on patients of color: patients who are African American, Asian American, or Native American. Caucasians can get it as well, but these other populations are at higher risk of getting it. When those patients present with lupus nephritis, they have more aggressive disease. I always tell my patients that I believe in aggressive treatment because some of these patients can get end-stage renal disease, meaning the kidneys aren’t functioning as they should, and then these patients unfortunately have to go on to dialysis. That’s what lupus nephritis looks like.

If you think about patients with lupus and lupus nephritis, thankfully lupus nephritis is rare. But I’ll use an analogy. If 3 patients with lupus walk into my clinic and I haven’t seen any of them, done a diagnosis, or given any medication, 1 will have lupus nephritis at diagnosis. That means that when I do the blood test, I’ll see abnormalities that correlate with kidney disease. Then when we look inside the urine, we can see protein and blood cells in the urine—things that shouldn’t be there normally that we see in patients with lupus nephritis.

One of 3 patients with lupus will get lupus nephritis, and some patients who don’t have lupus nephritis at baseline can develop it over a period of years. This is why I stress that even patients who have lupus but don’t have lupus nephritis at baseline still need to be evaluated. I see my patients like clockwork every 3 months to make sure patients who are stable today aren’t going to have change in their urine that’s going to be a hallmark of lupus nephritis 6 months or a year from now.

Transcript edited for clarity.

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