How to manage lupus with declining kidney function at 34?

Question

Hello doctor,

I am a 34-year-old woman living with lupus, and my nephrologist recently informed me that my kidneys are now affected. My urine tests have shown elevated protein levels, and I have been experiencing significant bloating, fatigue, and swelling in my ankles.

I recently started treatment with CellCept and Prednisone; however, I am feeling concerned because my kidney function continues to decline. My creatinine level has increased from 1.2 to 1.6 over the past few months.

Does this indicate that the current treatment may not be effective?
Should I be discussing additional testing or more aggressive treatment options with my care team?
I would also appreciate insight into the long-term outlook for someone my age living with lupus nephritis.

Please help.

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com.

Thank you for sharing your experiences. It sounds like you are dealing with a lot right now, and it is quite fair to be concerned. Let us go over what could be happening and what options are normally examined.

What might be going on?

Your symptoms, which include ankle edema, bloating, high urine protein, and an increase in creatinine, are consistent with lupus-induced kidney inflammation, often known as lupus nephritis. Unfortunately, lupus nephritis can worsen even after treatment begins, especially in the early months of medication.

What do higher creatinine and protein levels indicate?

Creatinine is a sign of renal function, and a rise from 1.2 to 1.6 is alarming but not necessarily permanent, especially given that you are still in early treatment. Elevated protein levels in urine indicate that the kidney's filtering units are inflamed or damaged.

Is this an indication that the treatment is not working?

Not necessarily. CellCept (mycophenolate mofetil) and prednisone are two medications that can take weeks or months to fully manage inflammation. An early elevation in creatinine does not necessarily indicate therapy failure; it could indicate persistent inflammation that has not yet resolved.

Should you look into more testing or treatment options?

This is an appropriate moment to discuss the next steps with your nephrologist. Possible considerations could include:

Early in treatment, kidney function and urine protein levels are closely monitored every two to four weeks.
If the pattern or degree of inflammation has changed, a repeat kidney biopsy is recommended.
Adjusting or increasing immunosuppressive medication, such as considering cyclophosphamide if CellCept is inadequate.

Optimizing supportive therapy, including drugs like ACE(angiotensin-converting enzyme) inhibitors or ARBs(Angiotensin II Receptor Blockers), can assist protect kidney function.

Long-term prognosis.

Because you are young, many people with lupus nephritis can have favorable long-term results, especially if they are treated early and regularly monitored. However, uncontrolled disease can raise the chance of developing chronic kidney disease, which is why early therapy adjustments and constant monitoring are critical.

I hope the information helps.

Kindly revert so I can assist you further.

Thank you.