Category Archives: Lupus

Hello, I am a 30 yo female with a history of Turner syndrome, common variable Immunodeficiency, and undifferentiated connective tissue disease (leaning towards lupus). I have had high blood pressure since I was about 21. I take Celexa, Plaquenil, and IVIG infusions. Since January 6 I have been on 10 mg of prednisone. I have been on my higher doses for longer periods of time previously though with no issues. Last year it was stable on just 10 mg of lisinopril (I had lost 30 lbs with diet and got off of 25 mg of metoprolol). My heart rate had been running in the 90s-100s and was but after losing weight was in the 80s at resting. 5 weeks ago my blood pressure started spiking to the 140s/90s. I had also noticed then even though my resting heart rate was 80s it would go up into the 110s within minutes when I would get up and move around. Cardiology placed me back on 25 mg of metoprolol. My blood pressure responded then 2 days later started spiking again and went to 158/100. The metoprolol was doubled to 50 mg. I did have a CMP at this time that showed GFR and creatinine were normal. My blood pressure started responding and then started going back up again and was 140s over 90s in the cardiologist office. I was also having episodes of dizziness, lightheadedness and palpitations. I also noticed my ankles looked swollen even though it was not pitting edema. The metoprolol was doubled again and now 100 mg. The echo was not concerning although I was showing quite a few PVCs though which I have never done before. Aldosterone, renin, and magnesium labs were done. My aldosterone and magnesium where normal but my renin was very high (33.4 with a range of 0.5-4). With my history of systemic autoimmune disorder I have been referred to nephrology to take a look. I also started have right kidney pain (full throbbing not sharp) and noticed the edema became stage 1-2 pitting when I would wake up, and I had one day where I did not have to urinate for 10 hours even though I drank almost 64 oz during that time. I have kept track of my diet for the past 5 weeks and have kept my sodium at about 1000-1500 mg/day and I only drink water and drink about 64 to 80 oz a day. The multiple UAs I had done since last summer had all show 1+ protein, one also showed 1+ ketones, and another one also showed hyaline casts. The UA I had done last week had a specific gravity of less than 1.005 and did not show any protein but did show amorphous crystals. I have not had a 24 hour urine done. If I have read literature correctly the urine being so dilute could give a false negative on the protein and could be caused by kidney disease. The soonest I can get into nephrology is May and in the meantime I am very concerned with all that my kidneys are having trouble. I have a kidney ultrasound scheduled next week but nothing else to look further at my kidneys. Am I correct that my kidneys could be trouble with all of this information? I am not sure what else to do if they are in trouble in the meantime while I wait to see nephrology.

The situation that you describe is very complex and difficult to establish an underlying diagnosis.  I am unable to make a specific diagnosis based on the information that you present.  If your blood testing for kidney disease is normal and … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Lupus, Nephrologist, Proteinuria

I have stage one CKD. I found this out by seeing I have very foamy urine. I tested positive on the ANA blood test as well. I have been diagnosed with Lupus. What are the usual treatments for patients with what I have. Also, how long until immunosupressants like Prograf take to kick in and stop foamy urine?

I am unable to make a specific diagnosis based on the information that you present.  In most cases of systemic lupus nephritis, a kidney biopsy is necessary in order to make a specific diagnosis.  A specific diagnosis is necessary in … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Lupus, Urinary Tract Infection/Pyelonephritis

My wife, 66 yo, was recently diagnosed with kidney disease early stage kidney failure. Her protein numbers, etal remained somewhat steady for 6 months but on her last two labs they have shot up so the doctor ordered more aggressive treatment which includes prednisone and 2 chemo sessions. She never had a kidney biopsy and cancer has never been diagnosed. In fact by process of elimination the diagnosis is hereditary and high blood pressure. My wife did not ask why chemo if no cancer but I am really upset about it but don’t want to alarm her. Could there be another reason for the chemo? Thank You.

In order for your wife to receive chemotherapy for kidney disease, it is commonly necessary for your wife to sign a permit that she has received informed consent about the use of chemotherapy.  If your wife has not received informed … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Biopsy, Kidney Cancer, Kidney-Related Health Questions, Lupus, Nephrotic Syndrome

I’m a SLE patient. I’ve been having trouble with edema (especially in my legs), high blood pressure, and weight gain. My gfr was 70 in March it dropped to 55 in August. My creatinine was 1.1 in March. Should I be concerned about nephritis?

Patients with systemic lupus erythematosus (SLE) can get lupus nephritis and should be monitored for kidney disease.  I would recommend that you have both blood and urine testing for kidney disease.  I recommend that you review this with your physician

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Lupus

I am a SLE patient with chronic anemia issues, edema and hypertension. My most recent labs in August showed my gfr had dropped to 55. It was 70 in March. Could I be developing Lupus Nephritis?

Lupus nephritis may occur in patients with systemic lupus erythematosus (SLE).  Your physician would need to do testing to specifically diagnose nephritis.  This testing should include urine and blood testing.

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Lupus, Symptoms and Side Effects, Treatments

I’m on a number of medications for Rheumatoid Arthritis and Lupus. In October, my eGFR was 104 but it has steadily declined and, as of yesterday, was 82. My doctor reported that my labs looked “good” and my lupus is “under control” but I’m terrified by those numbers! Am I panicking for nothing? Should I seek out a nephrology referral just to be safe?

The normal for estimated glomerular filtration rate (eGFR) is greater than 60 milliliters per minute per 1.73 meters squared. If your urinalysis is normal and does not show any blood, protein and infection, then you likely do not have kidney … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Lupus

Dr. Spry, In May, 2017 my GFR was 70.1. I do not have diabetes. I have all the symptoms of lupus with, possible diagnosis. I have scleroderma and Sjogren’s as well. I have also tested positive for anti-phospholipid syndrome, with no blood clots to date. I started having kidney pain about two months ago. My specialist ran my labs again and my GFR is now 56. It has fallen 14 points in almost exactly two years. She seemed unconcerned. My mom also has kidney disease. Should I be concerned? I was considering going to a nephrologist because my health insurance does not require referrals. Any advice is appreciated.

It would be important to also do a urine test for blood, protein and infection to look for kidney disease. The urine should also be examined under the microscope to look for red blood cells and casts. I am unable … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney-Related Health Questions, Lupus

Sir, I have lupus nephritis. I checked my routine blood test and the result was: Creatinine 5.1, Urea 183, WBC 2500, Hgb 7.0. I’m on medicines such as Solumedrol & Colstim Aciloc Alphadol 0.25mg. Please tell me a good treatment for me?

I am unable to recommend treatment without performing a complete history and physical examination.  I am unable to make a specific diagnosis based on the information that you present.  You may have lupus nephritis but your kidney tests are very … Continue reading

Posted in Ask the Doctor, Kidney-Related Health Questions, Lupus, Nephrologist

Thank you so much, Dr. Spry. I have Lupus, Sjogren’s, and Hashimoto’s. I got bloodwork back the other day and my eGFR was down from 75 May 2, to 66 Sept. 1. My (random) urine was checked and Albumin was 40.8% & Total Protein was 23.3. UAlbumin 40.8% (9.5 mg/dl) UAlpha1 59.2% (13.8mg/dl). Urine Creatinine 189.5 mg/dL. My SERUM BUN/Creatinine Ratio was Low @ 8. SERUM Creatinine is 0.96 (rising). The nurse indicated that there was nothing remarkable about these values. My father was on dialysis for years and passed at 63. Glomerulonepritis. I am 57 now. I think these values warrant further investigation, as kidney disease has affected several other paternal relatives as well. But I don’t know how to go about doing anything about it. I am concerned about Lupus Nephritis, also. I have Anemia of Chronic Disease, and Polyclonal Hypergammaglobulinemia dx through a bone marrow aspirate nearly 20 years ago. But no one ever knew what to do with that information. I’m very worried about my kidneys. Can you help me understand if my concerns are warranted? Thanks again, in advance.

When interpreting the estimated glomerular filtration rate (eGFR), we use normal as being anything greater than 60 milliliters per minute per 1.73 meters squared. Hence, the laboratory cannot reliably tell the difference between 75 and 66. These numbers within the … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Dialysis, GFR, Glomerulonephritis, Kidney-Related Health Questions, Laboratory Testing, Lupus

Should a person take Cellcept with kidneys functioning at 100%? My spouse is a lupus pt and was recently prescribed this medication due to swelling in his legs and feet. I am doing some research on this medication and very concerned about him taking it. He was prescribed 500mg a day for 2 weeks, then two tablets a day for 2 weeks, then 3 tablets a day. I am concerned about damage to his kidneys from the use of this medication and also concerned about immunosuppression.

Cell Cept (mycophenolate mofetil) is a immunosuppressive medication used in lupus patients to prevent damage to major organs such as his kidneys.  I am not able to make a specific diagnosis based on the information that you present.  I am … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Lupus, Medication and Kidney Disease, Medication and Kidney Function, Symptoms and Side Effects, Treatments