Kidney Damage, Dialysis, Transplants, & Lupus

Lupus Warriors and doctors need to be on the lookout for signs of organ involvement. Unfortunately, the signs of kidney damage can be easy to overlook.

Lupus can cause inflammation throughout the body, including internal organs. While skin involvement (in the form of a facial rash) and arthritis are common, the heart, lungs, and kidneys can also be damaged by chronic flare-ups. You may not be aware of any kidney damage until you are nearing kidney failure, because symptoms can be easily overlooked until only 10 percent of one kidney is functioning.

In fact, lupus is one of the most common underlying conditions leading to the need for permanent dialysis or a kidney transplant. Dialysis helps keep your body in balance by performing the typical duties of the kidneys including:

• removing waste, salt, and extra water
• maintaining a balance of chemicals like potassium and sodium
• helping control blood pressure

To learn more about dialysis, check out The National Kidney Foundation.

Signs & symptoms of kidney damage

The main indicators of kidney damage are revealed in laboratory tests, particularly tests that analyze blood and urine. These tests are commonly ordered and evaluated by your lupus treatment team. In fact, a study found that the primary concern for clinicians was screening their patients for organ involvement.

Four common warning signs that damage is occurring in the kidneys are:

1. High blood pressure (hypertension)
2. Blood and or protein in the urine
3. A glomerular filtration rate less than 60
   • identified via blood test
4. A creatinine level and blood urea nitrogen (BUN) above the normal range
   • identified via blood test

Preventing the need for dialysis

Changing your normal daily diet may be necessary if you are experiencing kidney damage. This can help slow the progression.

Too much salt (sodium) in your daily intake can raise your blood pressure. This is true for people without lupus as well. Reducing salt is a good strategy to improve overall health because high blood pressure is linked to an increased risk of heart attack, stroke, and kidney failure.

If you have kidney disease, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) recommends the following diet changes:

• Eat small portions of protein food items
• Consume food items and beverages with less phosphorus (P)
• Consume foods with the right amount of potassium (K) to avoid K build-up in kidneys

Considering a kidney transplant

Lupus Warriors that also experience kidney failure (resulting from lupus nephritis) will likely require lifetime dialysis. Another option may be a kidney transplant. However, finding a viable donor, or waiting for an organ, can present challenges.

While organ rejection is far less common in transplant recipients from a living related donor, it does require a family member with a matching blood type. Additionally, because there is a genetic component to lupus, it is possible that a family member may also have lupus and would not be a possible donor.

The other alternative is to receive an organ from a deceased person via a donation. Waiting time for a cadaver donor kidney can be 10 years, so adults experiencing kidney failure often receive dialysis on a regular basis prior to notification of a matching cadaver donor kidney.

If you are considering a kidney transplant, speak with your lupus treatment team about the challenges, risks, and personal considerations.

Living with lupus and a kidney transplant

Kidney transplant recipients are typically placed on anti-rejection (immunosuppressive) medications for life – except when the donor is an identical sibling (e.g., identical twin). While these drugs reduce the likelihood of the kidney being rejected by the recipient’s body as “foreign tissue”, side effects adversely impacting health are common.

Listed on the National Kidney Foundation website are the following four classes of maintenance immunosuppressive medications prescribed to kidney transplant recipients:

1. Calcineurin Inhibitors: (e.g., Tacrolimus and Cyclosporine).
2. Antiproliferative agents (e.g., Mycophenolate Mofetil, Mycophenolate Sodium, Azathioprine)
3. mTOR inhibitor (e.g., Sirolimus)
4. Steroids (e.g., Prednisone)

One of the main side effects of immunosuppressive medication is a heightened risk for infection. According to an article in the Clinical Journal of American Society of Nephrology, cytomegalovirus (CMV) is the most common infection in kidney transplant recipients.

Symptoms listed by the Centers for Disease Control include fever, fatigue, and swollen glands (and it is diagnosed by blood testing). This opportunistic infection in immunocompromised people is linked to a heightened risk for an eye inflammation termed retinitis. Anti-viral medications are usually prescribed to treat a CMV infection in immunocompromised patients.

Looking to learn more?

Check out this 2018 article titled Lupus Nephritis: An update on treatments and pathogenesis

Also, the Lupus Foundation of America shares information on lupus nephritis