Some types of kidney damage occur through activation of the immune system causing inflammmation. Lupus (SLE) affecting the kidney, vasculitis, and Goodpasture's. In nephrotic syndrome, a variety of disorders cause proteinuria, often resulting in marked edema and hypoalbuminemia. Hyperlipidemia is a common associated finding. How is lupus treated? Learn more here. Lupus symptoms vary from one person to another. In many cases, the best treatment approach is with a health care team that. INTRODUCTION: Exogenous lipoid pneumonia (ELP) is caused by the inhalation of animal fats, vegetable or mineral oil. It is commonly seen in patients at high risk for. Partners MS Center is located at the Brigham and Women's Hospital, Harvard Medical School. We focus on the care of patients with multiple sclerosis and other. A diagnosis of hypermobility is made when a physical exam shows excess range of motion of certain joints. Your doctor will check for other features that suggest your. What are the symptoms of kidney problems associated with Lupus? Is pain associated with the problem? Brentwood, MO The unfortunate problem with Lupus related.Lupus Nephritis: Practice Essentials, Background, Pathophysiology. Yung S, Chan TM. Anti- DNA antibodies in the pathogenesis of lupus nephritis- -the emerging mechanisms. Autoimmun Rev. 7(4): 3. Davidson A, Berthier C, Kretzler M. Pathogenetic mechanisms in lupus nephritis. Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus and Related Syndromes. Philadelphia, PA: Elsevier Saunders; 2. Mechanisms of progression of renal damage in lupus nephritis: pathogenesis of renal scarring. Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. 2. 00. Feb 2. 8. 3. 58(9): 9. Update on human systemic lupus erythematosus genetics. Curr Opin Rheumatol. Nath SK, Kilpatrick J, Harley JB. Genetics of human systemic lupus erythematosus: the emerging picture. Curr Opin Immunol. Wong M, Tsao BP. Current topics in human SLE genetics. Springer Semin Immunopathol. Harley JB, Kelly JA, Kaufman KM. Unraveling the genetics of systemic lupus erythematosus. Springer Semin Immunopathol. Harley JB, Alarc. Genome- wide association scan in women with systemic lupus erythematosus identifies susceptibility variants in ITGAM, PXK, KIAA1. Collaboration, genetic associations, and lupus erythematosus. N Engl J Med. 2. 00. Feb 2. 8. 3. 58(9): 9. Kaiser R, Criswell LA. Genetics research in systemic lupus erythematosus for clinicians: methodology, progress, and controversies. Curr Opin Rheumatol. Mohan C, Adams S, Stanik V, Datta SK. Nucleosome: a major immunogen for pathogenic autoantibody- inducing T cells of lupus. Muller S, Dieker J, Tincani A, Meroni PL. Pathogenic anti- nucleosome antibodies. Interferon pathway activation in systemic lupus erythematosus. Curr Rheumatol Rep. The type I interferon system in systemic lupus erythematosus. Arthritis Rheum. 5. The innate immune system in SLE: type I interferons and dendritic cells. Arbuckle MR, Mc. Clain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med. 2. 00. Oct 1. 6. 3. 49(1. Hanly JG, O'Keeffe AG, Su L, Urowitz MB, Romero- Diaz J, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford). Galindo- Izquierdo M, Rodriguez- Almaraz E, Pego- Reigosa JM, et al. Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER). Medicine (Baltimore). Lim SS, Drenkard C. The Epidemiology of Lupus. Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus and Related Syndromes. Philadelphia, PA: Elsevier Saunders; 2. Lupus nephritis in children. Brunner HI, Gladman DD, Iba. Difference in disease features between childhood- onset and adult- onset systemic lupus erythematosus. Arthritis Rheum. 5. Bogdanovic R, Nikolic V, Pasic S, Dimitrijevic J, Lipkovska- Markovic J, Eric- Marinkovic J. Lupus nephritis in childhood: a review of 5. Pediatr Nephrol. 1. Clinical and epidemiologic features of lupus nephritis. Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus and Related Syndromes. Philadelphia, PA: Elsevier Saunders; 2. Faurschou M, Mellemkjaer L, Starklint H, et al. High risk of ischemic heart disease in patients with lupus nephritis. J Rheumatol. 3. 8(1. Rianthavorn P, Buddhasri A. Long- term renal outcomes of childhood- onset global and segmental diffuse proliferative lupus nephritis. Pediatr Nephrol. 3. Pisetsky DS, Gilkeson G, St. Systemic lupus erythematosus. Diagnosis and treatment. Med Clin North Am. Grande JP, Balow JE. Renal biopsy in lupus nephritis. Smith EM, Jorgensen AL, Midgley A, Oni L, Goilav B, Putterman C, et al. International validation of a urinary biomarker panel for identification of active lupus nephritis in children. Pediatr Nephrol. Anti- nucleosome antibodies in patients with systemic lupus erythematosus of recent onset. Potential utility as a diagnostic tool and disease activity marker. Rheumatology (Oxford). Su Y, Jia RL, Han L, Li ZG. Role of anti- nucleosome antibody in the diagnosis of systemic lupus erythematosus. Clin Immunol. 1. 22(1): 1. Bigler C, Lopez- Trascasa M, Potlukova E, Moll S, Danner D, Schaller M, et al. Antinucleosome antibodies as a marker of active proliferative lupus nephritis. Am J Kidney Dis. 5. Marto N, Bertolaccini ML, Calabuig E, Hughes GR, Khamashta MA. Anti- C1q antibodies in nephritis: correlation between titres and renal disease activity and positive predictive value in systemic lupus erythematosus. Ann Rheum Dis. 6. Sinico RA, Radice A, Ikehata M, Giammarresi G, Corace C, Arrigo G, et al. Anti- C1q autoantibodies in lupus nephritis: prevalence and clinical significance. Ann N Y Acad Sci. Sinico RA, Rimoldi L, Radice A, Bianchi L, Gallelli B, Moroni G. Anti- C1q autoantibodies in lupus nephritis. Ann N Y Acad Sci. Mok CC, Ho LY, Leung HW, Wong LG. Performance of anti- C1q, antinucleosome, and anti- ds. DNA antibodies for detecting concurrent disease activity of systemic lupus erythematosus. Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. Houssiau FA, Ginzler EM. Current treatment of lupus nephritis. Dooley MA, Falk RJ. Immunosuppressive therapy of lupus nephritis. Dooley MA, Ginzler EM. Newer therapeutic approaches for systemic lupus erythematosus: immunosuppressive agents. Rheum Dis Clin North Am. Kronbichler A, Neumann I, Mayer G. Moderator's view: the use of calcineurin inhibitors in the treatment of lupus nephritis. Nephrol Dial Transplant. Mok CC, Jayne D. Pro: The use of calcineurin inhibitors in the treatment of lupus nephritis. Nephrol Dial Transplant. Fernandez Nieto M, Jayne DR, Mok CC. Con: The use of calcineurin inhibitors in the treatment of lupus nephritis. Nephrol Dial Transplant. The Hopkins Lupus Pregnancy Center: ten key issues in management. Rheum Dis Clin North Am. Moroni G, Doria A, Giglio E, Tani C, Zen M, Strigini F, et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 2. A prospective multicenter study. J Autoimmun. American college of rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken). A long- term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group. Joint European League Against Rheumatism and European Renal Association- European Dialysis and Transplant Association (EULAR/ERA- EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 7. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong- Guangzhou Nephrology Study Group. N Engl J Med. 2. 00. Oct 1. 9. 3. 43(1. Ginzler EM, Dooley MA, Aranow C, Kim MY, Buyon J, Merrill JT. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med. 2. 00. Nov 2. 4. 3. 53(2. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med. 3. 50(1. Appel GB, Contreras G, Dooley MA, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med. 1. Ciruelo E, de la Cruz J, Lopez I, Gomez- Reino JJ. Cumulative rate of relapse of lupus nephritis after successful treatment with cyclophosphamide. Arthritis Rheum. 3. Somers EC, Marder W, Christman GM, Ognenovski V, Mc. Cune WJ. Use of a gonadotropin- releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus. Arthritis Rheum. 5. Dooley MA, Jayne D, Ginzler EM, et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2. 01. Nov 1. 7. 3. 65(2. Tamirou F, D'Cruz D, Sangle S, Remy P, Vasconcelos C, Fiehn C, et al. Long- term follow- up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis. Ann Rheum Dis. 2. Mar 1. 0. Mok CC, Ying KY, Yim CW, Ng WL, Wong WS. Very long- term outcome of pure lupus membranous nephropathy treated with glucocorticoid and azathioprine. Silverman GJ. Anti- CD2. Arthritis Rheum. 5. Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ. B cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose- escalation trial of rituximab. Arthritis Rheum. 5. Leandro MJ, Cambridge G, Edwards JC, Ehrenstein MR, Isenberg DA. B- cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 2. Rheumatology (Oxford). Ng KP, Leandro MJ, Edwards JC, Ehrenstein MR, Cambridge G, Isenberg DA. Repeated B cell depletion in treatment of refractory systemic lupus erythematosus. Ann Rheum Dis. 6. Merrill JT, Neuwelt CM, Wallace DJ, et al. Efficacy and safety of rituximab in moderately- to- severely active systemic lupus erythematosus: the randomized, double- blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 6. Looney RJ, Anolik J, Sanz I. New therapies for systemic lupus erythematosus: cellular targets. Rheum Dis Clin North Am. Abetimus sodium (riquent) for the prevention of nephritic flares in patients with systemic lupus erythematosus. Rheum Dis Clin North Am. Kirou KA, Salmon JE, Crow MK. Soluble mediators as therapeutic targets in systemic lupus erythematosus: cytokines, immunoglobulin receptors, and the complement system. Rheum Dis Clin North Am. Haarhaus ML, Svenungsson E, Gunnarsson I. Ofatumumab treatment in lupus nephritis patients. Clin Kidney J. 9 (4): 5. Wallace DJ, Stohl W, Furie RA, et al. A phase II, randomized, double- blind, placebo- controlled, dose- ranging study of belimumab in patients with active systemic lupus erythematosus. Arthritis Rheum. 2. Sep 1. 5. 6. 1(9): 1. Care of the Lupus Patient. Lupus symptoms tend to present themselves according to the body system affected. These symptoms vary over time in intensity and duration for each patient as well as from patient to patient. To effectively care for a lupus patient, the nurse or other health professional needs an up- to- date knowledge and understanding of the disease, its many manifestations, and its changing and often unpredictable course. This article provides an overview of general and system- specific lupus manifestations and identifies potential problems. Suggested health care interventions for the nonhospitalized lupus patient are given. Many of these interventions can be modified for the hospitalized patient. The information and nursing interventions described in this article are not meant to be inclusive, but to provide the practitioner with guidelines for developing a care plan specific to the needs of each lupus patient. As a care plan is developed, the health professional should keep in mind the importance of frequently reassessing the patient's status over time and adjusting treatment to accommodate the variability of SLE manifestations. An additional and very important element of working with the lupus patient is to incorporate the patient's needs and routines in the plan of care. Adjusting nursing interventions and medical protocols to the patient's needs not only recognizes the value of the patient as an authority on her or his own illness but also can improve patient compliance and result in an improved quality of life. Working together, the care provider and the patient have much to offer each other. The rewards are tremendous for the patient and family as independence is gained and the trust in the ability to care for oneself is strengthened. Continued. Systemic Lupus Erythematosus. General Manifestations. Fatigue, fever, psychological and emotional effects. Specific Manifestations. Dermatologic: Butterfly rash, photosensitivity, DLE, subcutaneous LE, mucosal ulcers, alopecia, pain and discomfort, pruritus, bruising. Musculoskeletal: Arthralgias, arthritis, other joint complications. Hematologic: Anemia, decreased WBC count, thrombocytopenia, lupus anticoagulants, false- positive VDRL, elevated ESR. Cardiopulmonary: Pericarditis, myocarditis, myocardial infarction, vasculitis, pleurisy, valvular heart disease. Renal: Asymptomatic microscopic renal involvement, renal failure, fluid and electrolyte imbalance, urinary tract infection. Central Nervous System (CNS): General CNS symptomology, cranial neuropathies, cognitive impairment, mental changes, seizures. Gastrointestinal: Anorexia, ascites, pancreatitis, mesenteric or intestinal vasculitis. Ophthalmologic: Eyelid problems, conjunctivitis, cytoid bodies, dry eyes, glaucoma, cataracts, retinal pigmentation. Other Key Issues. Pregnancy: Lupus flare, miscarriage or stillbirth, pregnancy- induced hypertension, neonatal lupus. Infection: Increased risk of respiratory tract, urinary tract, and skin infections; opportunistic infections. Nutrition: Weight changes; poor diet; appetite loss; problems with taking medications; increased risk of cardiovascular disease, diabetes, osteoporosis, and kidney disease. Systems Potentially Affected by Lupus. General Manifestations of SLEOverview. Fatigue is a nearly universal complaint of patients with SLE even when no other manifestations of the disease are present. The cause of this debilitating fatigue is not known. The patient should be evaluated for factors that may exacerbate fatigue, such as overexertion, insomnia, depression, stress, anemia, and other inflammatory diseases. Fatigue in SLE patients may be lessened by adequate rest, healthful diet, exercise, and attention to psychosocial factors. Many patients with SLE experience changes in weight. At least one- half of patients report weight loss before being diagnosed with SLE. Weight loss in SLE patients may be attributed to a decreased appetite, side effects of medications, gastrointestinal problems, or fever. Weight gain can occur in some patients and may be due in part to prescribed medications, especially corticosteroids, or fluid retention from kidney disease. Episodic fever is experienced by more than 8. SLE patients, and there is no particular fever pattern. Although high fevers can occur during a lupus flare, low- grade fevers are more frequently seen. A complicating infection is often the cause of an elevated temperature in a patient with SLE. The patient's WBC count may be normal to elevated with an infection, but low with SLE alone. However, certain medications, such as immunosuppressives, will suppress the WBC even in the presence of fever. Therefore, it is important to rule out other causes of a fever, including an infection or a drug reaction. Urinary and respiratory infections are common in SLE patients. Continued. Psychological and emotional effects, such as grief, depression, and anger, are commonly experienced by lupus patients. These can be related to the outward changes, such as skin alterations, caused by the disease as well as by other aspects of the disease and its treatment. It is important for health professionals to be alert to potential psychological repercussions and to assist in alleviating them. Potential Problems. Inability to complete activities of daily living (ADL) because of fatigue, weakness, and psychological difficulties. Changes in weight. Fever. Nursing Interventions. Objective: Minimize Fatigue. Assess patient's general fatigue level. Assess for the presence of depression, anxiety, and other stressors. Conduct assessment to determine patient's daily activities that contribute to fatigue. Help patient to develop an energy- conserving plan for completing daily and other activities and work. Suggest planning for rest periods as needed throughout the day to conserve energy. Encourage patient to get 8- 1. Encourage exercise as tolerated. Objective: Maintain Weight at Optimal Range. Assess patient's prescription and non- prescription drug regimen and dosages. Assess the patient's usual daily dietary intake by asking her or him to keep a food diary. Develop a dietary plan with the patient that encourages healthful eating. If the patient has nutrition- related lupus complications, refer her or him to a registered dietitian for specialized counseling. Encourage exercise as tolerated. Record patient's weight at each visit. Instruct patient to weigh herself or himself at home once a week and record it. Potential Physiological Manifestations. Fatigue. Weight gain or loss. Fever - - increased temperature over normal baseline. Elevated WBCPotential Psychological Manifestations. Lowered self- esteem. Negative feelings about body. Decreased confidence. Feelings of decreased self- worth. Depression. Feelings of sadness, hopelessness, helplessness. Difficulty in completing self- care activities, caring for children, maintaining a household, and other activities of daily living (ADL)Inability to maintain full- or part- time employment. Decreased social activities. Lack of energy or ambition. Irritability. Impaired concentration. Crying. Insomnia. Suicidal thoughts. Objective: Teach Patient to Recognize Fever and Signs and Symptoms of Infection. Assess patient's prescription and non- prescription drug regimen and dosages. Monitor patient's WBC count. Teach patient to monitor temperature during a lupus flare. Teach patient to look for signs and symptoms of infection, particularly urinary and respiratory infections. The classic sign of SLE is the . This rash ranges from a faint blush to a severe eruption with scaling. It is photosensitive, and it may be transitory or fixed. Between 5. 5 and 8. Other rashes may occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands. DLE is seen in 1. SLE. Subacute cutaneous LE, seen in about 1. SLE patients, produces highly photosensitive papules that itch and burn. Skin changes, especially the butterfly rash and subacute cutaneous LE, can be precipitated by sunlight. Some patients may develop mouth, vaginal, or nasal ulcers. Hair loss (alopecia) occurs in about one- half of SLE patients. Most hair loss is diffuse, but it may be patchy. It can be scarring or nonscarring. Alopecia may also be caused by corticosteroids, infection, or immunosuppressive drugs. Raynaud's phenomenon (paroxysmal vasospasm of the fingers and toes) frequently occurs in patients with SLE. For most patients, Raynaud's phenomenon is mild. However, some SLE patients with severe Raynaud's phenomenon may develop painful skin ulcers or gangrene on the fingers or toes. Continued. Varying levels of pain and discomfort due to skin alterations may occur. Pruritus accompanies many types of skin lesions. Attacks of Raynaud's phenomenon can cause a deep tingling feeling in the hands and feet that can be very uncomfortable. Both pain and itching may affect a patient's ability to carry out activities of daily living (ADL). Skin alterations in the lupus patient, particularly those of DLE, can be disfiguring. As a result, patients may experience fear of rejection by others, negative feelings about their body, and depression. Changes in lifestyle and social involvement may occur. Potential Problems. Alteration in skin integrity. Alopecia. Discomfort (pain, itching)Alteration in body image. Depression. Nursing Interventions. Objective: Minimize Appearance of Lesions. Document appearance and duration of lesions and rashes. Teach patient to minimize direct exposure to UV rays from sun and from fluorescent and halogen light bulbs. Patients who are allergic to PABA will need to find a PABA- free sunscreen. Provide information on hypoallergenic concealing makeup. Instruct patient to avoid topical applications, such as hair dyes and skin creams, and the use of certain drugs that may make her or him more sensitive to the sun. Objective: Alleviate Discomfort. For patients with mouth lesions, suggest a soft- food diet, lip balms, and warm saline rinses. Instruct patient to take medications that may help to alleviate discomfort and itching as ordered.
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