Lupus nephritis is a kidney disease caused due to lupus. While the disease has some very obvious symptoms; it is best to go in for detailed screening tests to ensure timely and correct diagnosis.
It is found that the first symptoms of Lupus Nephritis are often those which can be confused with symptoms of several other kidney disorders as a result preventing objective diagnosis of the disease. It is for this reason that doctors prescribe an array of screening tests to make sure the disease diagnosis and subsequent line of treatment are not affected.
Lupus Nephritis (LN), which is a kidney inflammation, is a disease stemming from the autoimmune disorder- Lupus. Lupus affects several parts of the body and affects the immune system’s normal functioning as well, by creating auto-antibodies that damage the cells and tissues of the body organs. When these auto-antibodies begin to deposit in the kidneys, they prevent its normal functioning.
Lupus Nephritis Facts and Trivia:
Some identifiable early manifestations of Lupus Nephritis are symptoms such as: Swelling of feet, eyes and legs; increase in blood pressure; frothy looking urine with presence of blood at times, as well as frequent urination.
Important Screening tests for Lupus Nephritis:
Here are some important screening tests for Lupus Nephritis that, determine the extent of kidney damage. These tests give the doctors a clear picture of the way the kidneys have been affected.
Blood tests: Blood tests for Lupus Nephritis are done for the following information; BUN: normal level<20; Albumin: normal level>3.5; Creatinine: normal level<1 (in women and may be higher than men due to higher muscle mass)
Creatinine Clearance test: this test is done by taking into account factors such as age, race and gender of the patient. Normal readings for this test are between 80-120 ml/min/1.73m2.
Urine tests: The following are the three types of urine tests done as part of LN screening:
- Urine analysis: this analysis is done to find traces of blood, protein and white blood cells in the urine, if any. Normal readings for this test are - <5 RBCs, <5 WBCs and 0 trace of protein.
- 24 Hour Urine Protein Test: Urine is cultured for 24 hours for further analysis. In this test Creatinine is also measured in order to ascertain whether sample was taken correctly. Normal readings for this test are < 300mg/24 hours. However, in case of Lupus, the readings show results > 500mg/24 hours.
- Spot Urine Protein/Creatinine ratio: The second urine of the day proves to be the ideal sample for this test as results vary depending upon the time of collection. Normal readings for this test are <300 mg/24 hours.
Renal Ultrasound: Usually doctors go in for kidney ultrasound to ascertain the tissue consistency and extent of damage to the kidneys.
Serology: this test studies the characteristics of the disease by testing the blood serums. It tests the following:
- Anti-dsDNA – results for this are high when the disease is active. Normal readings are = 0.
- Antiphospolipid antibodies – results for this show presence of lupus anticoagulant and anti-cardiolipin antibodies IgA, IgG and IgM. This result determines whether the patient needs blood thinners or not.
- C4 – levels of this blood serum are low when disease is active. Normal levels are >18.
- C3 – levels of this blood serum are also low when disease is active, normally the levels are >80.
Bone tests: several bone tests are done to ascertain the degree of damage and other side effects caused by the disease. These include tests such as: bone mineral density tests to rule out osteoporosis. Blood level of 25 OH Vitamin D which is normally at the level>30mg/ml and test to check the Blood Level of intact parathyroid hormone, high levels of which indicate advanced kidney damage.
Kidney Biopsy: kidney biopsy is suggested when doctors suspect extreme kidney damage and need to know the extent of scarring, in order to determine the class of LN and decide the line of treatment accordingly.
Some Other Tests:
- Electrolytes Tests: They are done to detect sodium, potassium, bicarbonate.
- Fasting Blood Sugar Test: this is done to rule out complications such as diabetes or those caused by strong medication.
- Hemoglobin test: to detect anemia caused as a result of blood loss caused by kidney damage.
- Fasting lipids test: if the results of this test are on the higher side it indicates nephritic syndrome.
- White blood cells: the level of these cells goes down in case the immune system is under attack and high infection.
- Platelets (PLT): the level of these blood platelets goes down due to increased bleeding during a disease or during therapy.
- Tests are also done to rule out HIV, Hepatitis B, Hepatitis C and Tuberculosis.
All these tests have varying results depending upon the state of the patient; whether the disease is in active state or dormant state. In many patients symptoms may not appear at all or may be confusing. A urine test is the best way to rule out other ailments before establishing LN as the diagnosis. If you are doubtful of your condition it is advisable to consult another reputed Nephrologist and get yourself screened once again as per further advice.