Due To A Geographical Relocation, I've Had Six Months Without

Posted on Tue, 19 Mar 2019

Question: Due to a geographical relocation, I've had six months without my SLE (lupus and ckd) medications. I never had the circumstances to get a consultation w/ nephrologist, in order to understand my kidney biopsy results. They are complex but the overarching discovery was FOCAL, GLOBAL Glomerulosclerosis . I also have poly- joint inflammation, pleurisy, alopecia , steroid related weight gain, lupus fog, random rashes, a declining gfr of 39, when last labs were done 6 months ago . I know essentially that esrd is soon likely so I am too anxious , confused , and depressed to keep fighting this probability. I've been sick for 11 years, and feel doomed. Do you know of anything that could snap me out of the malaise ? It's a damned mercurial illness and my energy is all but gone.

Answered by Dr. Dr. Antoneta Zotaj (2 hours later)

Brief Answer:
Explanation of the biopsy results in details below

Detailed Answer:
Hello,
Welcome to 'Ask a Doctor' service.

I reviewed your query and understand your concern with SLE and the effect it has on your kidneys, joints and other parts of your body. Unfortunately even the medications for SLE have potential side effects as well and may make you feel unwell.

As for the result of the biopsy:
- glomeruli are the microscopic structure of the kidney that does the filtration of the blood and brings out waste products by urine.
- focal means less than 50% of the glomeruli
- global means that those glomeruli that are affected are almost completely affected (not only parts of them).
- sclerosis means there is fibrous tissue there (similar to the scar tissues).

Unfortunately, SLE affects kidneys and kidney function so the low GFR (glomerular filtration rate- the rate the glomeruli filter the blood) gets lower with time due to damage of the glomeruli. On the other hand in your case, because the biopsy says "focal" it means that less than 50% of the glomeruli are affected and is better prognosis compared to diffuse disease which is the last stage of kidney disease.

The treatments try to slow down the progression of nephropathy. Unfortunately, there is no absolute medication or treatment that can snap out the malaise. Treatment for SLE needs to be coordinated by a nephrologist and a rheumatologist simultaneously and it is important to arrange consultations with these specialists together to continue the treatment appropriately and the necessary follow-ups.

Hope I answered your query, please let me know if I can assist you further.

Regards,

Antoneta Zotaj
General & Family Physician

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Above answer was peer-reviewed by : Dr. Arnab Banerjee