Free Press Journal

Nephritis: Medical experts tell us all you must know about it


In this Instagram pic posted by Selena Gomez, she holds hands with her kidney donor and best friend, Francia Raisa

If it wasn’t for Selena Gomez’s kidney transplant, lupus would still be a non-entity among diseases. Manasi Y Mastakar talks to medical professionals in a quest to simplify this illness for our readers

Selena Gomez recently made headlines when she revealed having undergone kidney transplant. The reason for her undergoing such a major surgery, as she claimed, was lupus nephritis. Back in 2015, the singer revealed to the world of suffering from the disease and the diagnosis had required Selena to undergo chemotherapy too. Opening about her suffering, Selena while speaking to a magazine, had said: “I was diagnosed with lupus, and I’ve been through chemotherapy. That’s what my break was really about. I could’ve had a stroke.”

And, the transplant was just the beginning. Since, it will take time for the new kidney to start working fully, Selena will have to take a lot of care and continue medications for a long time.

So what’s lupus?

Lupus is a chronic autoimmune disease that causes inflammation and a range of symptoms. According to the Lupus Foundation of America, the disease can damage any part of the body, including joints, skin and internal organs. “Lupus is a multi-system disease which occurs when the body’s immune system comes under attack. The immune system fails to differentiate between good cells and bad cells, and the cells end up attacking each other,” says Dr Behram Padriwala, Consultant Internal Medicine, Wockhardt Hospital.

 “The immune system in the body is normally responsible for fighting foreign substances in the body like germs and viruses, however, in autoimmune disease the immune system makes a mistake and attacks healthy tissues of your body causing different symptoms,” adds Dr Dipti Patel Consultant Rheumatology from Wockhardt Hospital.

The symptoms

Common symptoms of lupus are fatigue, fever, pulmonary problems, kidney problems, swollen joints, gastrointestinal problems, thyroid problems and dry mouth and eyes. “The symptoms depend on the organ involved and usually include oral ulcers, hair loss, photosensitive rash on face, joint pains as common problems,” says Dr Haresh Dodeja, Consultant Nephrologists and Transplant Physician, Fortis Hospital.

But since these symptoms can also be associated with other diseases, it becomes difficult to diagnose lupus initially. “The doctors will generally advice various tests. And if the doctor has a high index of suspicion that you have autoimmune disease, they will then diagnose it as lupus. But like I said, there needs to be high index of suspicion,” says Dr Behram. The tests normally include blood, urine and biochemical tests.

Lupus normally affects young people, the age groups of 15-40 is the most vulnerable. And it affects women more than men, for reasons not yet known. “The ratio of women to men is 9 to 1 or 90%. Lupus can often trigger after child birth, at menopause or puberty due to hormonal activity and change. It is more common in Asian and black women than Caucasians,” adds Dr Patel.

Though the causes of lupus are unknown, doctors and studies say that it might be because of the presence of viruses in the body, it might be genetics or even environment. “Lupus afflicts people who have a genetic predisposition, but at the same time environmental effects are also present. Since, in Lupus, the immune system of a person attacks their body tissues, it needs a trigger. This trigger comes from the environment in the form of sunlight, infections or medications (anti-seizure medicines, blood pressure medications and antibiotics),” enlightens Dr Mohan Thomas, Consultant Cosmetic Surgeon, Breach Candy Hospital.

Is it treatable?

At present lupus has no cure, but there are various treatments available, which enable a person to lead a healthy and normal life. Since lupus can affect any part of the body, treatment depends on the organ affected. Selena Gomez underwent kidney transplant, because that was the organ that was affected, but for different organs, the treatment differs. Says Dr Padriwala, “It can affect your lungs and heart as well. And not every person suffering from lupus needs surgery. It can be controlled with a heavy dose of medication. But if there’s fluid accumulation in the lungs or the heart, then that needs surgery.”

Selena Gomez has also undergone chemotherapy for lupus. Is chemotherapy the usual course of treatment or only used in some cases? How does chemotherapy help in treating lupus, since it is not related to cancer at all. “Chemotherapy is basically medical drugs given to kill certain cell lines in the body. They are usually used in cancer where-in large doses of these drugs help in killing the cancer cells. Chemotherapy is not the first line treatment and is only used when important body structures are involved. This reduces the very active immune response and helps the long-term remission of Lupus,” reveals Dr Thomas.

Other treatment methods, according to Dr Patel include, non-steroidal anti-inflammatory drugs (NSAIDs), hydroxychloroquine also known as an antimalarial drug; corticosteroids, such as prednisone and methylprednisolone by mouth, injection, or intravenously. “If the disease is severe immunosuppressive drugs such as azathioprine, methotrexate, cyclosporine, mycophenolate mofetil and Cyclophosphamide can be used,” she adds.

Living with lupus  

 Since lupus is a chronic autoimmune disease, the treatment is also long-term. “Lupus requires long-term treatment depending in organs involved. It carries a definite risk of relapse so requires long-term maintenance therapy once remission is achieved,” says Dr Dodeja.

“Periods of time when you have lupus symptoms are called flares or relapses. Periods of time when your symptoms are under control are called remissions. There is no way to predict when a flare will happen, how bad it will be, or how long it will last. When you have a lupus flare, you may have new symptoms in addition to those you have had in the past. Hence it is very important to continue your medications under supervision of your doctor to identify symptoms of relapse to prevent complications,” adds Dr Patel.

Why kidney?

It is said that around 60% of the lupus sufferers are susceptible to kidney problems. Lupus affecting the kidney, called lupus nephritis, is said to be the most severe lupus and can be life-threatening. “Kidney is one of the commonest organ affected and may range from mild disease with protein leakage to rapidly progressive severe disease requiring early dialysis and leading to permanent kidney damage. So it is essential to identify it early on and treat aggressively,” says Dr Dodeja.

Symptoms at a glance

  • The symptoms of lupus depend on the affected organ of your body. Symptoms of lupus when the kidneys are affected include generalised itching, chest pain, nausea, vomiting and leg swelling (edema).
    ·  If your brain is affected, common symptoms may include headaches, dizziness, hallucinations, or even stroke.
    ·  Lupus can also cause blood problems, anaemia, increases risk of bleeding or blood clotting and can also cause inflammation of the blood vessels.
    ·  If your lungs are affected, lupus increases your chances of developing inflammation of the chest cavity lining (called as pleurisy), which makes breathing painful.
    -If the heart is affected, lupus can cause inflammation of the heart muscle, arteries or heart membrane. Lupus also increases the chances of person developing cardiovascular diseases and heart attack.

Lupus and skin

Skin lupus is not so common among Indian patients, says Dr Thomas. But it can cause a range of skin reactions that are similar to other more common skin disorders, making diagnosis of the illness challenging in many cases. In some cases, the butterfly rash may be mistaken for rosacea, psoriasis, or eczema. This leads to delay in the right kind of diagnosis as they initially improve with tropical treatments. Skin disease in lupus can cause rashes or sores, most of which will appear on sun-exposed areas such as the face, ears, neck, arms and legs.

Nearly, 40-70 percent of the people suffer from this disease due to the exposure to ultraviolet rays from sunlight or artificial light.

Inflammation of the skin is often an early sign of lupus that usually results in thinning of the hair and loss of eyelashes, eyebrows, facial hair, and body hair.

For skin, laser and filler technology is an effective treatment to improve scarring and pigment disturbances and may be less risky than any other surgery. Such kind of treatment can be done only under expert supervision. The medications to treat lupus-related to skin conditions depend on the form of cutaneous lupus. Other some cases, treatment can also involve topical ointments, such as steroid cream or gel. In some cases, liquid steroids can be injected directly into the lesions.

Different types of Lupus

  • Systemic lupus erythematosus, or SLE, is the most common form of lupus.
  • Discoid lupus erythematosus causes a skin rash that doesn’t go away.
  • Neonatal lupusaffects newborn.
  • Drug-induced lupuscan be caused by certain medicines.

Selena Gomez isn’t the only celebrity

Lady Gaga: In 2010, Lady Gaga had told CNN that she tested “borderline positive” for lupus and had also admitted that it runs in her family. Gaga was recently admitted to the hospital for the treatment of fibromyalgia, which causes chronic musculoskeletal pain.

Nick Cannon revealed in 2012 that he has lupus, and even spoke with theLupus Foundation of America about living with the disease.

Singers Toni Braxton and Seal also suffer from the disease, and have spoken about their struggles.