Understanding Lupus Nephritis: The condition that made Selena Gomez undergo a kidney transplant

American actress and singer Selena Gomez, in 2017, shocked her fans when she announced she needed a kidney transplant. The 33-year-old, had been suffering from an auto-immune disease called lupus, which eventually led to kidney failure, and one that required a transplant. Let's understand more on her condition...

What is lupus
The autoimmune disease systemic lupus erythematosus (SLE) known as lupus, causes the immune system to attack and damage its own healthy tissues and organs. The condition produces various symptoms which impact different body parts including skin, joints, blood cells, heart, lungs and kidneys, while its intensity levels rise and fall throughout the course of the disease. The 15-44 age range of women faces elevated danger from this condition, which shows hereditary patterns because of both inherited factors and environmental elements which include sunlight exposure, and infectious diseases.

The condition produces several symptoms which include fatigue, joint pain, fever and facial rash that forms a butterfly shape and sun sensitivity. Doctors use blood tests to diagnose this condition through the presence of autoantibodies, including anti-dsDNA and decreased complement levels. The medical team treats this condition through medication which helps to control flare-ups and safeguard organs from damage.


What is lupus nephritis
The kidneys become targets of lupus attacks, which results in filter damage, and blood cleaning impairment through swelling and scarring. Up to 60% of lupus patients develop it, and it strikes 40-50% within five years of lupus diagnosis. The accumulation of immune complexes containing defective antibodies inside kidney tissues, leads to inflammatory damage which affects the glomeruli which are small blood vessels.

This condition is divided into six stages, which doctors determine through biopsy procedures, starting from class I mild mesangial changes, to class VI advanced sclerosis. The disease will advance silently until it reaches end-stage kidney disease, which requires patients to receive either dialysis treatment or kidney transplant surgery.

Symptoms of lupus nephritis
Unfortunately, lupus nephritis develops without showing any warning signs, hence those who have lupus, are always at risk. The first signs of this condition appear through three main symptoms which include protein leaks that produce foamy urine and blood in urine, body swelling from fluid accumulation, and elevated blood pressure and weight increase. Some people notice their urine has turned dark, along with frequent urination, and tiredness.

The body also experiences nausea, itching, poor appetite and shortness of breath during the advanced stages, when waste products accumulate in the blood. High blood pressure creates damage to the heart system. The early detection of protein and blood in urine through urine tests, allows doctors to identify kidney problems before they become severe. Blood tests help doctors detect kidney damage by monitoring how creatinine levels increase in the body.

How it leads to kidney failure
The body maintains a persistent inflammatory state which causes permanent damage to kidney filters, that results in their impaired ability to remove waste and maintain fluid balance. The development of end-stage renal disease (ESRD) results in kidney failure, which demands either dialysis, or kidney transplant for 10-22% of patients, who have lupus nephritis. The disease progression becomes faster when patients receive delayed medical care, and their lupus symptoms remain uncontrolled, or when they belong to African or Hispanic descent and their anti-dsDNA antibody levels remain elevated.

The kidneys in ESRD operate at less than 15% of their normal capacity, which results in dangerous toxin accumulation. The artificial blood filtration process of dialysis causes patients to become exhausted, yet it delivers superior life quality than what transplant surgery provides. Research indicates that lupus nephritis patients who need dialysis, become more vulnerable to death from infections and heart problems until they receive a transplant.
Selena Gomez' story
Selena Gomez revealed her lupus diagnosis in 2015, which led to her tour cancellations for medical care. The summer of 2017 brought the onset of lupus nephritis which destroyed her kidneys to the extent that she needed a transplant to survive. Her friend Francia Raisa donated a kidney which she described as the "ultimate gift. "

Transplant as a lifeline
A kidney transplant involves using a functioning donor kidney to replace the non-functioning kidneys, which have stopped working. For lupus nephritis, success matches other causes, if lupus is controlled for 6-12 months pre-surgery. Research shows that transplant recipients survive at a rate of 93% throughout their first five years of treatment, but dialysis patients survive at 83% during this period. The survival rates for these patients reach 84% at ten years, but dialysis patients only survive at 60% during this time.

Risks
The treatment process carries three main risks which consist of rejection of the transplant, potential infection, and lupus flare but patients receive anti-rejection medication for protection. Patients must monitor their lupus symptoms, together with graft performance from the start of their post-transplant period. The transplant procedure in Gomez's case demonstrated that it enables patients to achieve typical life functions, with minimal restrictions.




Disclaimer: This article is informational only and not a substitute for medical advice