the Causes of Elevated Creatinine Levels in Lupus Patients

Causes of elevated creatinine levels?

I have systemic lupus erythematosus, which was diagnosed in 2009.
At that time, my serum creatinine level was 4.4.
After receiving steroid treatment, it decreased to 2.5.
I have since been under the care of rheumatology and nephrology.
However, from March 2015 to April 2016, my creatinine levels rose to 3.0, then 3.3, 3.9, and finally 4.1.
I underwent a kidney biopsy, and the nephrologist informed me that it was nephritic syndrome, while the rheumatologist indicated that I also have chronic pyelonephritis.
In my most recent blood test, my creatinine level reached 4.1.
Currently, my rheumatologist says that my lupus is stable and has reduced my medication, thus ruling out lupus as the cause of my kidney function deterioration.
However, I am experiencing anemia, with hemoglobin levels dropping to 6.7, which increased to 8.3 after taking iron supplements.
The nephrologist prescribed sodium bicarbonate (which I am taking) and medication to lower uric acid (which I have not yet taken).
My urine tests show a chloride level of 109 and a CO2 content of 17, but the cause of the chronic pyelonephritis remains undetermined, and no aggressive treatment has been initiated since my urine tests consistently show normal white blood cell counts.
The doctor stated that further testing cannot be performed.
I have also been experiencing vulvar itching and frequent urination (high frequency, low volume) around my menstrual periods.
I have been purchasing antifungal suppositories from the pharmacy, but this winter, the condition has been recurring and difficult to resolve.
As for the frequent urination, tests have consistently shown normal results, but my creatinine levels continue to rise.
I would like to know what other factors could potentially cause the deterioration of my kidney function, considering I do not have diabetes or hypertension.
My kidney function has worsened within this year (from 2.5 to 4.1).
If the underlying cause can be identified, is there a possibility for recovery?

Mei Mei, 30~39 year old female. Ask Date: 2016/04/08

Dr. Lin Peifeng reply Internal Medicine

The provided information is limited.
Lupus nephritis can cause six types of pathological changes in the kidneys, some of which are acute changes.
In such cases, the use of stronger immunosuppressants and corticosteroids may improve some kidney function.
However, if the changes are chronic, it usually indicates that kidney function is unlikely to recover.
Based on the information given, it is highly probable that lupus has led to chronic kidney disease over time, and it may have progressed to stage 5.
In the future, there is a significant likelihood of requiring renal replacement therapy, such as hemodialysis, peritoneal dialysis, or kidney transplantation.
It is recommended to consult and discuss with a nephrologist for long-term follow-up.

Reply Date: 2016/04/08

More Info

Elevated creatinine levels in patients with lupus can be a complex issue, as lupus itself can lead to various renal complications, including lupus nephritis and other forms of kidney damage. In your case, the progression of your creatinine levels from 2.5 to 4.1 over a relatively short period indicates a significant decline in kidney function, which warrants careful consideration of potential underlying causes.

Lupus nephritis is a common complication of systemic lupus erythematosus (SLE), where the immune system attacks the kidneys, leading to inflammation and damage. The fact that you have been diagnosed with both nephritis and chronic pyelonephritis suggests that there may be multiple factors contributing to your elevated creatinine levels. Chronic pyelonephritis, an infection of the kidney, can lead to scarring and loss of kidney function over time. If this condition is present, it could be exacerbating the renal impairment associated with lupus nephritis.

Your recent kidney biopsy indicating renal parenchymal disease suggests that there is intrinsic kidney damage, which could be due to ongoing inflammation from lupus or other factors. The presence of anemia, as indicated by your hemoglobin levels, can also complicate the clinical picture. Anemia can be a result of chronic disease, including lupus, and can further impact kidney function by reducing oxygen delivery to the kidneys.

The fluctuation in your creatinine levels, along with the persistent symptoms of urinary frequency and discomfort, raises the possibility of a urinary tract infection (UTI) or another underlying issue that may not have been fully addressed. While your urine tests have shown normal white blood cell counts, it is important to consider that some infections may not present with typical laboratory findings. Additionally, recurrent yeast infections and the use of over-the-counter treatments may indicate an imbalance in your urinary flora, which could contribute to your symptoms.

In terms of management, it is crucial to work closely with both your rheumatologist and nephrologist to address the multifaceted nature of your condition. They may consider adjusting your immunosuppressive therapy, optimizing your management of anemia, and investigating further for any potential infections or complications that could be contributing to your renal decline.
As for the potential for recovery of kidney function, it largely depends on the underlying cause of the deterioration. If the renal impairment is primarily due to reversible factors, such as an infection or medication side effects, there may be a chance for improvement. However, if there is significant irreversible damage due to chronic conditions, the focus may shift to managing the symptoms and preventing further decline.

In conclusion, the causes of elevated creatinine levels in lupus patients can be multifactorial, including lupus nephritis, chronic pyelonephritis, and other renal complications. It is essential to identify and address all contributing factors to optimize kidney function and overall health. Regular follow-ups, comprehensive evaluations, and a collaborative approach among your healthcare providers will be key in managing your condition effectively.

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