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Copyright 2012. Nova Science Publishers, Inc. All rights reserved.

. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 24 Ana Maria Abreu Velez and Michael S. Howard

torso. When these nerves do not communicate properly with the spinal cord, a peripheral
neuropathy results. A peripheral neuropathy may cause pain, numbness, tingling, burning or
itching. Some 10-25% of lupus patients may have one or more seizures as part of their disease
[59-61]. Finally, patients with antiphospholipid syndrome are at risk for stroke [62].

Lupus and the Kidney

In lupus patients, the kidney is often seriously affected by the disease. Lupus nephritis
represents disease inflammation of the kidney, characterized by damage to these organs and
progressive loss of kidney function [66-71]. Symptoms and signs of lupus nephritis include 1)
blood and/or protein in the urine, 2) elevated blood pressure, 3) abnormal blood serum studies
and 4) swelling of the ankles, hands and face. Lupus nephritis may develop into a life-
threatening complication of the disease [65-71]. Lupus nephritis ascites is defined as
excessive fluid build up within the peritoneal cavity, secondary to kidney inflammation and
failure. Estimates vary depending on the type of clinic and the patient population studied, but
it is usually estimated that approximately half of all lupus patients will have clinical evidence
of kidney inflammation within their clinical course [66-71]. In mild cases of lupus, the
nephritis percentage will be lower. Fortunately, severe kidney disease requiring kidney
dialysis or transplantation is rare in lupus. Kidney involvement in lupus rarely causes
discomfort or pain (as distinct, for example, from kidney stones or renal infections) [66-71].
The most common clinical renal problem is excessive protein (albumin) leakage into the
urine. The excess protein loss may be mild and detected only via testing, or severe and result
in lowering of the blood protein (ie, a low plasma albumin level) [66-71]. If the blood
albumin concentration is lowered, ankle swelling, fluid retention and truncal edema may
result. Further, when the kidney is inflamed, blood pressure frequently rises; blood pressure
measurement is thus important in any physical examination of lupus patients [66-71]. When
the kidney is more severely damaged, its normal filtering process is impaired; toxic
metabolites such as urea and creatinine (normally present in the blood in small amounts) build
up, leading to weight loss, nausea and general malaise [66-70]. Simple outpatient urine testing
involves the use of a urine dipstick. Modern urine dipsticks test for a variety of substances in
the urine, including glucose, albumin protein, blood and so on. The test involves dipping the
dipstick in the urine, and comparing resultant color changes to a interpretation chart. If the
lupus patient is losing excess protein in the urine (proteinuria) then the amount of protein loss
may need to be quantified [66-71]. Often, this is accomplished by evaluating the ratio of
albumin to creatinine in a sample of urine (ie, the albumin: creatinine ratio), which is
technically easier than measuring the total protein in all patient urine over a 24 hour period
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[66-71]. The patient urine may also be sent to the laboratory for detection of infectious
agents, and for further detailed microscopic examination. The three primary blood tests
affected by kidney function include 1) the urea (ie, blood urea nitrogen or BUN), 2) creatinine
and 3) albumin [66-71]. The creatinine may be further utilized to calculate the estimated
glomerular filtration rate (eGFR), which permits grading of the severity of kidney disease;
stage 1 represents the mildest disease, and stage 5 the most severe. Overall, if the filtering
function of the kidney is impaired, then serum BUN and creatinine levels rise and the eGFR
falls. The serum albumin falls if significant, pathologic leakage of albumin into the urine is
present. In addition to these tests, other blood tests give important information regarding the

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