Relevance of Kidney Disease in Children With Lupus - Assignment Example

? Relevance of Kidney Disease in Children with Lupus [College] An alarming research findings was reported by John Hopkins Children’s Center that children with lupus have more lethal form of kidney disease. This denotes that kidney failure is seriously related to lupus pediatric patients. The aim of this article is to make my own research project regarding the relevance of kidney failure to children with lupus and how severe would that be. Research articles that present statistics and in-depth study of lupus disease and how it effects kidney function will attest to this findings. In that case, research study may contribute awareness and familiarity, as well as necessary action in handling patients, especially children, with lupus. Relevance of Kidney Disease in Children with Lupus Introduction Systematic Lupus erythematosus (SLE), or Lupus, in its simple term, is a chronic autoimmune disease. Autoimmune disease is an illness that occur when the body’s immune system becomes hyperactive and functions abnormally by attacking various normal and healthy tissues of the body. The body’s immune system is designed to fight bacterial agents and other foreign microbes, or antigens, that entered into human body. Under normal function, the body’s immune system produces antibodies that are made up of proteins to protect and fight the antigens such as viruses and bacteria. In lupus patients, the immune system produce abnormal antibodies in their blood. With abnormal antibodies, immune system is now unable to distinguish healthy tissues from antigens, therefore the immune system will direct the antibodies against healthy tissues rather than the foreign infectious agents or antigens, causing swelling, pain, and damage to body tissues and organs such as skin, kidneys, blood, heart and lungs (Shiel & Stoppler, n.d.) . But how come kidneys are complicatedly affected? The normal function of kidneys are to remove waste materials from the human like creatinine and urea from the blood. Creatine is a subset of protein, wherein antibodies are also made up of protein. If the blood contains high levels of creatinine and urea, kidney weaken its function. That’s why if blood or protein in the urine is found during a urine test, it is a sign of kidney damage. Since immunity system of a lupus patient abnormally produce antibodies that are made up of protein, high level of it inside the body, especially in the blood will tend to a kidney failure. So, presumably children with lupus might develop kidney failure. Literature Review: According to research conducted by John Hopkins Children’s Center (2010), that in more than 98,000 children and adults with different kinds of end-stage kidney disease (ESKD), those with lupus, Systematic Lupus Erythematosus (SLE), have a more lethal form of kidney disease. Researchers analyzed data specifically reports that “children with lupus kidney disease had more than twice (2.4 times) the risk of dying compared to children with other forms of kidney disease” (para.5). Research analysis was based on 98,483 ESKD patients, wherein 171 of them were children with lupus, with the record of 29 fatalities, while in non-lupus ESKD, among 3,276 children 316 died. The reported common cause of death was heart disease due to complication. Also, according to their research analysis, that among children with lupus, eighty percent suffer kidney disease, commonly called Lupus Nephritis, and with the recorded number of deaths seventy-five percent died of heart failure, mostly heart attack. Base on this statistical report seriously speaking, lupus and kidney disease is a deadly combination. Research analysis shows that the vital organs that are commonly and primarily affected by lupus are heart and kidneys. How does lupus affect our kidneys? Dr. Carl F. Anderson (2010) explained first how lupus manifest in one human body. Being an autoimmune disease, as I explained in my introduction, the body’s immune system mistakenly recognized our own tissue as pathogens. Thereby, our immune system will produce antibodies, known as autoantibodies, that will neutralize the mistaken threat, which is actually a part of us. Buildup of autoantibodies determined to target proteins in the small blood vessels of the kidneys, then inflammation develops widespread leading to kidney failure, known as Lupus Nephritis. The common symptoms are presence of blood in the urine, high blood pressure, and swelling of the feet and lower legs. However, as he suggests, it is better that once lupus is being diagnosed, a doctor must right away recommend a urine test and a blood test, instead of waiting for the symptoms manifestation. He continues to suggest that these tests should be done periodically. Then, once the problem is detected, a kidney biopsy must be undertaken to determine the severity of the kidney failure and to take the appropriate treatment. Sampling methods: Lupus diagnosis, especially its complications in body’s vital organ are not easily detectible. Even doctors find a hard time for early diagnosis. So, that best way to make a research project regarding the relevance of kidney failure to children with lupus is by consulting research materials performed by medical specialists. By analyzing data, statistical report, and results of their study, I can find a reasonable answer regarding the issue of the relevance of kidney failure to children with lupus, and how serious is the complication. Methodology: . By analyzing the research study performed by known institutions and medical personnel, especially the report presented by John Hopkins Children Center, it evidently shows that lupus has greatly affected children’s kidney function. In fact, this effect has been admitted by various medical personnel that tend them to do further research to minimize the effect especially on children. Not only that, some medical authorities are performing concurrent researches to improve treatment and medication. By gathering further research articles and by reviewing and analyzing those materials that I gathered through internet websites, further proof of lupus relevance to kidney failure can be presented. I hereby present a more in-depth review on research articles performed by some medical specialists that are earnestly seeking early prevention and possible remedy of Lupus and its related complication with kidney failure. Like what Chi ChiuMok’s (2010) acknowledged in his research article regarding the importance of early detection of SLE with kidney complication. He clarifies that early detection to administering of treatment of renal activity may tend to spare patients from intensive immunosuppressive therapies, with its corresponding adverse reactions, and may also reduce renal damage. He adds that based on the statistics analysis of scenario of lupus nephritis in the past two decades, despite the overall improvement in the care of SLE, diagnosis result remains unsatisfactory. To improve the situation, implementation of newer effective strategies with lower toxicities are essential. However, these can be achieved by reformation of current procedures, combination strategies, and more precise aiming at the immunopathogenetic pathways by different biological agents. According to study, current laboratory biomarkers for SLE lack sensitivity and preciseness for differentiating renal activity and damage in SLE. Therefore, new biomarkers that can discern lupus renal activity and its severity, predict renal flares, can examine treatment response and disease progress are very important. It must also be easy to analyze, simple to interpret, and must be easily obtainable at reasonable cost. So in this particular research study, biomarkers that have been recently studied are systematically reviewed wherein information is grouped under three different subheadings; “(1) biomarkers that correlate with SLE renal activity on longitudinal studies, (2) biomarkers that correlate with lupus nephritis activity in cross-sectional studies, and (3) biomarkers that correlate with renal histology or prognosis of lupus nephritis”(p. 2). Additionally, Chi ChiuMok discusses Monocyte chemoattractant protein-1 (MCP-1), a leukocyte chemotactic factor that is engaged in interfering between inflammation and injury in lupus nephritis. Clinical study reports that SLE patients with active nephritis have high level of MCP-1 but reduces after immunosuppressive treatment. Recent cross-sectional studies have confirmed that lupus nephritis patients have higher level of urine MCP-1 than those with inactive renal disease. A study was conducted in a group of SLE adult patients by measuring urinary MCP-1 (uMCP-1) levels at the time lupus flares up, and during and after flares up, it appears that uMCP-1 level was remarkably higher at the time of renal break out than of healthy controls. Additionally, clinical test proves that uMCP-1 was found to be a sensitive indicator for renal flare. But even though uMCP-1 is considered to be a promising biomarker for lupus nephritis due to its sensitivity in predicting renal flares, further longitudinal confirmation by studies on a larger group of lupus patients is necessarily recommended. Further discussion of the article is about the Neutrophil Gelatinase-Associated Lipocalin (NGAL), a small glycosylated protein produced in many body tissue and organs that plays an important role in transporting cellular iron. It is normally attached at low levels in the kidneys but measured high during acute renal injury and various insults such as inflammation, ischemia, and infection. An increased level of urinary and plasma NGAL to a child that undergone cardiopulmonary bypass surgery has possible acute kidney injury. According to ChiuMok, a more recent longitudinal study proved that urine NGAL level was a substantial predictor of renal disease activity in lupus patients. However, the article review shows, that even though number of new biomarkers have been studied in cases of lupus nephritis, still, none of the them have been thoroughly proven in large-scale longitudinal study of group of patients especially with various ethnical background. The article dictates that although conventional clinical ways of testing are not sensitive enough for detecting early relapse of lupus nephritis, new biomarkers cannot replace these conventional ways. Otherwise, the review suggests or recommends further research using the combination of methods, the new ones and the conventional ones, to enhance sensitivity and specificity of predicting lupus nephritis. Patrick FK Yong and David P. D’Cruz (2010) review article about studies on Mycophenolate mofetil (MMF) treatment of lupus nephritis relates that “the assessment of lupus nephritis has improved recently with the updated histological WHO classification by the International Society of Nephrology and the Renal Pathology Society (p. 297). The updated classification composing of 6 classes, Class I, II, III, IV, with sub-classes as IV-S and IV-G, V and VI, has enabled more meaningful assessment of histological specimens between various cores and allowed standardization of clinical trials. Treatment and dose of intravenous medication varies according to classes, not necessarily categorized as severity stage. While early diagnosis is very important, yet, it appears that researchers find it as a major and continuing challenge until now. So, in cases that lupus nephritis manifested especially at the early stage of lupus, renal biopsy is the initial step to be taken. A research article written by Hobbs et al. (2009), presented a research study and positive result of repeated renal biopsy in an interval of six months performed on 21 children composing of various ethnical groups. The purpose of the study was to evaluate clinically pathologic features, including anticardiolipin antibody (aCL), short-term clinical and renal histologic outcomes of children with newly onset of SLE nephritis. Even before the onset of symptoms of SLE, appearance of antibodies triggered SLE and the presence of aCL antibodies impacts negatively on renal outcomes and a possible severe kidney disease. According to the study article, “pediatric patients with SLE and antiphospholipid antibodies, primarily lupus anticoagulants (LAC) and elevated aCL antibody, are also at risk of developing thromboembolic events”(Introduction section, para.2). This must be given major concern since SLE pediatric patients exhibit a higher incidence of s antibody than adults. Therefore, early screening of aCL antibody in children patients would be of great help in determining whether a child is at risk of poor renal outcomes, severe disease course and thromboembolism. Different treatment were used in respective groups consisting of methylprednisolone, corticosteroids, cyclophosphamide or mycophenolate mofetil. Then after six months of treatment, a follow-up renal biopsy is performed to assess for therapeutic management. Then, another laboratory studies were to be conducted, which includes aCL antibody. Then after six months, no patients were nephrotic or required hemodialysis and demonstrated significant improvements in the result of their blood tests. Even after 12 months, wherein repeated renal biopsy were undertaken, patients showed significant improvements in the blood hemoglobin tests and other blood components, decreased level of aCL antibodies, and still, no children were found nephrotic. Therefore, despite the severity of cases to children at the initial presentation, such as 90% prevalence of aCL antibody which is associated with high blood pressure, nephrotic syndrome and need for hemodialysis, after two repeated renal biopsy in an interval of six months successively, while administering treatment, resulted to positive results of improved condition. With the process of repeated renal biopsy, aCL antibody associated with renal histology are considered to be a reliable biomarker of severity of SLE nephritis and an instrument of treatment response to severe pediatric SLE nephritis. Data Analysis: Based from my article reviews on my research materials that I hereby presented, lupus complications on kidneys seem to be inevitable since early detection of lupus is still a challenging task for medical specialists and researchers. The strenuous efforts exerted by the researchers show that it is generally accepted in the field of medicine that kidney failure has relevance to lupus disease. Their behavior and attitude toward the possibility of finding prevention and remedy reveal the fact that kidney failure due to lupus is a serious matter. Additionally, efforts on equipping our medical personnel of updated information performed by the Lupus Foundation of America (LFA) with coordination of RN.com, RxSchool.com, and Dr. Mary Anne Dooley, Member, LFA's Medical-Scientific Advisory Council, by launching a new continuing education program for the nurses, pharmacists, and pharmacy technicians last April 14, 2011 is highly commendable. The program entitled ‘Lupus, Deciphering the Clues’ enhanced health professionals awareness of lupus diagnosis and treatments, to meet the needs of early diagnosis and treatment to avoid further vital organ complications (Medical News Today, 2011). Potential Limitations I was not able to interview medical personnel that directly involved in doing medical research regarding Lupus and its relevance to kidney failure. I never had a chance either to meet a Lupus Nephritis patient to conduct possible interview. Anyway, the statistical record presented by John Hopkins Children Center presents valid evidence that children with lupus are somehow exposed to kidney failure, and their kidney disease is a more lethal form than those of non-lupus patient. Additionally, the tireless effort of some medical research specialists proved true how serious is the problem brought about by lupus in relation to kidney failures. References Anderson, C. F., (2010). How does lupus affect my kidneys?. Retrieved Nov. 10, 2011 from http://www.mayoclinic.com/health/lupus/AN01267 ChiuMok, C. (2010). Biomarkers for lupus nephritis: A critical analysis. Journal of Biomedicine and Biotechnology. Retrieved Nov. 11, 2011 from http://www.hindawi.com/journals/jbb/2010/638413/ Hobbs, D. J., Barletta, GM., Rajpal, J. S., Rajpal, M. N., Weismantel, D. P., Birmingham, J. D., & Bunchman, T. E. (2009). Severe pediatric systematic lupus erythematosus nephritis – a single-center experience. Oxfotd Journals. Retrieved Nov. 12, 2011 from http://ndt.oxfordjournals.org/content/25/2/457.full John Hopkins Children’s Center (2010). Children with lupus have more lethal form of kidney disease. Retrieved Oct. 25, 2011 from http://www.hopkinschildrens.org/Children-with- Lupus-Have-More-Lethal-Form-of-Kidney-Disease.aspx Medical News Today. (2011) Lupus foundation of America and RN.com launch new lupus education program. Retrieved Oct. 26, 2011 from http://www.medicalnewstoday.com/releases/222406.php Shiel, W. C., & Stoppler, M. C., (n.d.). Systematic Lupus Erythematosus. Medicine Net.com. Retrieved Nov. 22, 2011 from http://www.medicinenet.com/systemic_lupus/article.htm Yong, P. FK. & D’Cruz, D. P. (2008). Mycophenolate mofetil in the treatment of lupus nephritis. Biologics: Targets & Therapy, 2(2). Retrieved Nov. 12, 2011 from www.dovepress.com/mycophenolate-mofetil-in-the-treatment-of-lupus-nephritis-a1734 Read More