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LUPUS NEPHRITIS

Systemic lupus erythematosus (SLE) is an autoimmune disorder which occurs when the immune system attacks one’s own healthy body cells in different areas. Lupus nephritis is a serious complication of SLE which results when the kidney cells get attacked by the immune system. Nearly 60% of the patients with SLE develop lupus nephritis. In this condition the kidneys become inflamed and cannot function efficiently.

Symptoms

The first symptom which is noticed in people with lupus nephritis is the swelling or edema in the feet, legs and ankles which can worsen with days. Sometimes there can be swelling in the face and hands. The other symptoms of lupus nephritis are similar to the other kidney diseases, which may include:

  • Blood in urine
  • Dark colored urine
  • Foamy or cloudy urine
  • Weight gain
  • High blood pressure
  • Frequent urination especially at night times

Risk factors

Both men and women of any age group can develop lupus nephritis. However, it is more common in women. Additionally, the below factors can increase the risk of lupus nephritis:

  • A family history of the condition
  • Environmental factors such as toxic chemicals or pollutants
  • Infections especially caused by viruses

Diagnosis

The doctor may recommend further tests based on the above mentioned symptoms. The following are the tests performed for the diagnosis of lupus nephritis.

  • Physical examination is performed to check for abnormal heart and lung sounds.
  • Urine test helps in monitoring the levels of proteins eliminated through urine over a period of 24 hours. This gives the filtering ability of the kidneys. Urine tests are also conducted to identify the levels of red blood cells and white blood cells.
  • Blood tests help in checking the level of waste materials such as urea and creatinine which are usually elevated in kidney diseases.
  • Lothalamate clearance test is performed to measure the rate at which kidneys filter the waste materials. This is done by injecting radioactive iothalamate into the blood and the time in which it is excreted in urine is noted.
  • Imaging tests such as ultrasound is conducted to look for abnormalities in the shape and size of the kidneys.
  • Biopsy in which a sample tissue is collected from the kidneys and microscopically analyzed for the signs of damage.

Treatment

The main goal of the treatment is to delay or prevent the worsening of the condition. However, lupus nephritis cannot be completely cured. Treatment helps in relieving the symptoms and prevents the need for kidney transplant. Treatment is based on the type of lupus nephritis and the patient’s overall health. The following are the treatment options for lupus nephritis.

  • Blood pressure medicines such as calcium channel blockers or beta blockers or ACE inhibitors or ARBs are given either alone or in combinations.
  • Diuretics or water pills are given to remove excess fluid from the body.
  • Blood-thinning medications may be given to prevent the formation of blood clots.
  • Corticosteroid drugs are given to reduce inflammation. However, careful monitoring is required due to the risk of potential side effects with these drugs. Also, the dose is tapered down once the symptoms improve.
  • Immune suppressing agents may be given to prevent the immune cells from attacking the healthy kidney cells.
  • Additionally, the doctor will suggest the patient to reduce the intake of salt and proteins to reduce the work load of the kidneys.

If the kidney damage is severe, then additional treatment such as dialysis may be necessary. Dialysis is an artificial method of filtering the wastes from the body using a machine. In some patients, kidney transplant is the final option.

Complications

People with lupus nephritis have a risk of developing acute or chronic kidney failure and need dialysis or kidney transplant.

Prevention

Taking prompt treatment for SLE helps to prevent lupus nephritis.

Gingivitis

Gingivitis is the inflammation of the gums and is usually associated with bacterial infections. Generally, it precedes gum disease (periodontitis) but may not always progress to periodontitis. If the condition is not treated, it can lead to the separation of the gums from the teeth and tooth loss.

Symptoms

People with mild forms of gingivitis exhibit only mild symptoms which are difficult to identify. The symptoms may include:

  • Soft gums
  • Swollen gums
  • Receding gums (pulling back of the gum margins surrounding the teeth)
  • Bad breath that does not resolve with good oral hygiene
  • Purple to bright red colored gums
  • Bleeding of the gums while brushing or flossing
  • Tenderness in the gums
  • Sensitive teeth

Causes

Gingivitis results from excessive plaque deposits on the teeth. Plaque is a sticky film which builds up on the teeth due to the interaction of bacteria with food in the mouth. If the plaque is not regularly removed by brushing and flossing, it gets collected under the gum line and turns into a harder substance known as tartar. This can irritate the gum line. Prolonged periods of gingival irritation can lead to gingivitis.

Hormonal changes which occur during pregnancy, menstruation, or with the use of contraceptive pills may increase the sensitivity of the gums and lead to gingivitis.

Risk factors

The following factors increase the likelihood of a person to develop gingivitis:

  • Advancing age
  • Regular smoking
  • Crooked teeth which is difficult to clean
  • Improper fitting of dental appliances
  • Diseases such as diabetes, cancers, HIV
  • Medicines such as certain anticonvulsants and anti-angina medicines which affect the salivary flow
  • Vitamin C deficiency in the diet
  • A family history of gingivitis
  • Pregnancy

Complications

If proper treatment is not taken for gingivitis, it can lead to periodontitis. A severe form of gingivitis known as necrotizing ulcerative gingivitis (NUG) or trench mouth which causes pain, bleeding from the gums, ulcerations and infection may also develop if gingivitis is not managed properly.

Gum inflammation present for prolonged periods can lead to respiratory diseases, stroke, rheumatoid arthritis, and coronary artery disease.

Sometimes the bacteria can enter the blood circulation and affect the lungs, kidneys, heart and other parts of the body.

When to consult the doctor?

Consult the dentist as soon as the signs and symptoms of gingivitis are noticed. This helps to prevent the progression of the disease.

Diagnosis

Diagnosis involves taking the dental and medical history of the patient. This is followed by a physical examination of the gums, teeth, tongue and mouth to check for the signs of inflammation or plaque. Examination of the gums includes probing them with a small ruler. This helps the dentist to check for inflammation and determine the depth of the pockets around the teeth. If the depth is more than 3 millimeters, it indicates gum disease.

Treatment

Gingivitis usually resolves by practicing good oral hygiene such as a timely brushing and flossing of the teeth and using mouthwashes.

In general, treatment of gingivitis is carried out by a periodontist (specialist in treating gum diseases). Treatment options include:

Professional dental cleaning

It includes procedures such as scaling and root planing. Scaling removes the tartar and plaque from the surfaces of the teeth and gums. Root planing removes the plaque, prevents further development of plaque and tartar, and smoothens the root surfaces. This helps in resolving gingivitis in most of the patients.

Medicines

  • Antiseptic mouthwashes are given to disinfect the mouth.
  • Oral antibiotics may be given to overcome the persistent infection.
  • Antibiotic microspheres may be inserted into the pockets after scaling and root planning.

Surgery

  • Bone and tissue grafts may be used in case of severely damaged teeth and jaw which does not heal with medicines.
  • Flap surgery may be performed by lifting the gums back to remove the plaque and suturing the gums back in place to snugly fit around the teeth.

Prevention

It may be possible to prevent gingivitis by taking the below measures:

  • Maintaining good oral hygiene such as brushing the teeth twice daily and flossing between the teeth at least once everyday
  • Regularly visiting the dentist (once for every 6 to 12 months)
  • Eating a healthy diet to strengthen the immune system
  • Proper management of conditions such as diabetes

LUPUS NEPHRITIS

Systemic lupus erythematosus (SLE) is an autoimmune disorder which occurs when the immune system attacks one’s own healthy body cells in different areas. Lupus nephritis is a serious complication of SLE which results when the kidney cells get attacked by the immune system. Nearly 60% of the patients with SLE develop lupus nephritis. In this condition, the kidneys become inflamed and cannot function efficiently.

Symptoms

The first symptom which is noticed in people with lupus nephritis is the swelling or edema in the feet, legs and ankles which can worsen with days. Sometimes there can be swelling in the face and hands. The other symptoms of lupus nephritis are similar to the other kidney diseases, which may include:

  • Blood in urine
  • Dark colored urine
  • Foamy or cloudy urine
  • Weight gain
  • High blood pressure
  • Frequent urination especially at night times

Risk factors

Both men and women of any age group can develop lupus nephritis. However, it is more common in women. Additionally, the below factors can increase the risk of lupus nephritis:

  • A family history of the condition
  • Environmental factors such as toxic chemicals or pollutants
  • Infections especially caused by viruses

Diagnosis

The doctor may recommend further tests based on the above mentioned symptoms. The following are the tests performed for the diagnosis of lupus nephritis.

  • Physical examination is performed to check for abnormal heart and lung sounds.
  • Urine test helps in monitoring the levels of proteins eliminated through urine over a period of 24 hours. This gives the filtering ability of the kidneys. Urine tests are also conducted to identify the levels of red blood cells and white blood cells.
  • Blood tests help in checking the level of waste materials such as urea and creatinine which are usually elevated in kidney diseases.
  • Lothalamate clearance test is performed to measure the rate at which kidneys filter the waste materials. This is done by injecting radioactive iothalamate into the blood and the time in which it is excreted in urine is noted.
  • Imaging tests such as ultrasound is conducted to look for abnormalities in the shape and size of the kidneys.
  • Biopsy in which a sample tissue is collected from the kidneys and microscopically analyzed for the signs of damage.

Treatment

The main goal of the treatment is to delay or prevent the worsening of the condition. However, lupus nephritis cannot be completely cured. Treatment helps in relieving the symptoms and prevents the need for kidney transplant. Treatment is based on the type of lupus nephritis and the patient’s overall health. The following are the treatment options for lupus nephritis.

  • Blood pressure medicines such as calcium channel blockers or beta blockers or ACE inhibitors or ARBs are given either alone or in combinations.
  • Diuretics or water pills are given to remove excess fluid from the body.
  • Blood-thinning medications may be given to prevent the formation of blood clots.
  • Corticosteroid drugs are given to reduce inflammation. However, careful monitoring is required due to the risk of potential side effects with these drugs. Also, the dose is tapered down once the symptoms improve.
  • Immune suppressing agents may be given to prevent the immune cells from attacking the healthy kidney cells.
  • Additionally, the doctor will suggest the patient to reduce the intake of salt and proteins to reduce the work load of the kidneys.

If the kidney damage is severe, then additional treatment such as dialysis may be necessary. Dialysis is an artificial method of filtering the wastes from the body using a machine. In some patients, kidney transplant is the final option.

Complications

People with lupus nephritis have a risk of developing acute or chronic kidney failure and need dialysis or kidney transplant.

Prevention

Taking prompt treatment for SLE helps to prevent lupus nephritis.

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