The Official Patient's Sourcebook on Lupus (18 page)

option. Type in “lupus nephritis” (or synonyms). As this service is oriented

to technology, you may wish to search for press releases covering diagnostic

procedures or tests that you may have read about.

Search Engines

Free-to-view news can also be found in the news section of your favorite

search engines (see the health news page at Yahoo:

http://dir.yahoo.com/Health/News_and_Media/,
or use this Web site’s

general news search page
http://news.yahoo.com/.
Type in “lupus nephritis”

(or synonyms). If you know the name of a company that is relevant to lupus

nephritis, you can go to any stock trading Web site (such as

www.etrade.com
) and search for the company name there. News items

across various news sources are reported on indicated hyperlinks.

BBC

Covering news from a more European perspective, the British Broadcasting

Corporation (BBC) allows the public free access to their news archive located

at
http://www.bbc.co.uk/
. Search by “lupus nephritis” (or synonyms).

94 Lupus Nephritis

Newsletter Articles

If you choose not to subscribe to a newsletter, you can nevertheless find

references to newsletter articles. We recommend that you use the Combined

Health Information Database, while limiting your search criteria to

“newsletter articles.” Again, you will need to use the “Detailed Search”

option. Go directly to the following hyperlink:

http://chid.nih.gov/detail/detail.html
. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that

you prefer. For the format option, select “Newsletter Article.”

By making these selections, and typing in “lupus nephritis” (or synonyms)

into the “For these words:” box, you will only receive results on newsletter

articles. You should check back periodically with this database as it is

updated every 3 months. The following is a typical result when searching for

newsletter articles on lupus nephritis:

·
Lupus and Pregnancy: Can They Go Together?

Source: Lupus News. 20(5): 8-11. Winter 2000.

Contact: Available from Lupus Foundation of America. 1300 Piccard

Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-

9292. Fax (301) 670-9486. Website: www.lupus.org/lupus.

Summary: This newsletter article uses a question and answer format to

provide women who have lupus with information on managing a

pregnancy. Lupus is more common among women than men, and it is

often diagnosed during the childbearing years. Therefore, women with

lupus are faced with the difficult decision of whether or not to become

pregnant. Most women who have lupus can have successful pregnancies.

One of the most common questions women who have lupus ask is how

pregnancy will affect their lupus. Although recent studies show that

lupus flares are common in pregnancy, most are mild or moderate and

are manageable. Women who have lupus nephritis appear to be at more

risk during pregnancy than women without kidney disease, and recent

studies support this observation. However, most women with lupus

nephritis, particularly women with well controlled lupus nephritis, have

a satisfactory pregnancy outcome. Another issue of concern to women

with lupus is how it will affect them and their baby during pregnancy.

Pregnancy loss is one complication. Women who have antiphospholipid

syndrome are at particular risk for pregnancy loss. Preeclampsia is a

common complication in all pregnancies, but some patients with lupus

are at greater risk for this complication than others, including women

using steroids, women with kidney damage, and women with lupus

Periodicals and News 95

nephritis. Other complications that women or their baby may experience

include preterm birth, fetal growth impairment, and neonatal lupus

erythematosus. Women with lupus may also be concerned about the

effect of the drugs used to treat lupus on their pregnancy. Drugs that may

safely be used to treat lupus during pregnancy are glucocorticoids. A

final issue of concern to women with lupus is prenatal care. The article

offers guidelines for prepregnancy, prenatal, and postnatal care and care

during labor and delivery.

·
Lupus Nephritis: A Practical Guide for the Patient

Source: Lupus News. 19(1): 1,3-5. Winter 1998-1999.

Contact: Available from Lupus Foundation of America. 1300 Piccard

Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-

9292. Fax (301) 670-9486. Website: www.lupus.org/lupus.

Summary: This newsletter article provides people who have systemic

lupus erythematous (SLE) with information on lupus kidney disease, also

known as lupus nephritis. Estimates indicate that more than half of the

patients who have lupus will develop lupus nephritis. Early diagnosis

and treatment of lupus nephritis and good followup care are important to

ensuring a normal lifespan for patients with SLE. The article explains the

normal physiology of the kidney and identifies the mechanisms

responsible for lupus nephritis. Lupus kidney disease occurs when

immune complexes build up in the kidneys and activate other proteins in

the blood called complement. Activation of complement releases

chemicals that cause inflammation and result in possible damage to

kidney tissue. Symptoms of lupus nephritis include edema and foamy,

frothy urine. The diagnosis of is generally made by established criteria.

Urine tests that are helpful in diagnosing lupus nephritis are analyzing

an early morning specimen and a 24 hour collection. Blood studies that

assess blood urea nitrogen and serum creatinine and monitor the levels of

anti-DNA antibodies and serum complement are helpful in monitoring

lupus nephritis. A kidney biopsy may be needed to determine whether

kidney tissue is inflamed or scarred and the severity of the inflammation

and scarring. The biopsy will confirm the diagnosis of lupus nephritis,

determine the extent of the disease, and classify the type of lupus that is

present. Treatment options include using prednisone or

immunosuppressive agents such as azathioprine or cyclophosphamide in

conjunction with prednisone. In addition to drug therapy, patients who

have lupus nephritis should quit smoking, control high cholesterol with

diet and exercise, and maintain normal weight. Patients who actively

participate in their treatment plan will increase the likelihood of a

positive outcome. 3 figures and 3 tables.

96 Lupus Nephritis

·
Facing Lupus Nephritis

Source: Lupus Horizons. 21(2):8-10; Fall 1997.

Contact: Greater Atlanta Chapter of the Lupus Foundation of America,

150 Interstate North Parkway, NW, Suite 285, Atlanta, GA 30339-2201.

(800) 800-4FLA. (770) 952-3891.

Summary: This newsletter article for health professionals and individuals

with lupus focuses on lupus nephritis. Reasons why individuals with

lupus may fear kidney disease are presented. The types of tests that are

useful in the evaluation of patients with suspected nephritis are

described, including urinalysis, immunologic tests, and kidney biopsy. In

addition, drug therapies that are effective for the treatment of lupus are

highlighted, including corticosteroids, chemotherapy, diuretics, and

antihypertensives. Dialysis or kidney transplantation may be required if

kidney failure develops.

·
Kidney Transplantation

Source: SLE Newsletter. 19(2):3,13; Summer 1996.

Contact: Bay Area Lupus Foundation, Inc., 2635 North First Street, Suite

206, San Jose, CA 95134. (408) 954-8600.

Summary: This newsletter article for health professionals addresses the

issue of kidney transplantation for patients with lupus nephritis. Kidney

involvement with lupus nephritis occurs in approximately 10 percent of

patients with systemic lupus erythematosus. Although advances have

been made in the treatment of lupus nephritis during the past decade,

some patients still lose kidney function completely and develop end stage

renal disease (ESRD). Once ESRD develops, patients must undergo

dialysis or kidney transplantation. Issues that physicians should consider

prior to kidney transplantation are examined, including how soon after

the onset of kidney failure, when kidney transplantation should occur,

whether the risk of developing SLE is too great in a relative to allow

kidney donation, whether a patient's tissue type will affect the outcome

of kidney transplantation, and whether a woman with a history of SLE

should become pregnant after kidney transplantation.

Academic Periodicals covering Lupus Nephritis

Academic periodicals can be a highly technical yet valuable source of

information on lupus nephritis. We have compiled the following list of

periodicals known to publish articles relating to lupus nephritis and which

are currently indexed within the National Library of Medicine’s PubMed

Periodicals and News 97

database (follow hyperlinks to view more information, summaries, etc., for

each). In addition to these sources, to keep current on articles written on

lupus nephritis published by any of the periodicals listed below, you can

simply follow the hyperlink indicated or go to the following Web site:

www.ncbi.nlm.nih.gov/pubmed
. Type the periodical’s name into the search box to find the latest studies published.

If you want complete details about the historical contents of a periodical, you can also visit
http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi
. Here, type in the name of the journal or its abbreviation, and you will receive an index

of published articles. At
http://locatorplus.gov/
you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher).

Select the button “Search LOCATORplus.” Then type in the name of the

journal and select the advanced search option “Journal Title Search.” The

following is a sample of periodicals which publish articles on lupus

nephritis:

·
American Journal of Kidney Diseases : the Official Journal of the

National Kidney Foundation. (Am J Kidney Dis)

http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A

merican+Journal+of+Kidney+Diseases+:+the+Official+Journal+of+the+

National+Kidney+Foundation&dispmax=20&dispstart=0

·
Archives of Pediatrics & Adolescent Medicine. (Arch Pediatr Adolesc

Med)

http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Archi

ves+of+Pediatrics+&+Adolescent+Medicine&dispmax=20&dispstart=0

·
Arthritis and Rheumatism. (Arthritis Rheum)

http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar

thritis+and+Rheumatism&dispmax=20&dispstart=0

·
Biochemical and Biophysical Research Communications. (Biochem

Biophys Res Commun)

http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi

ochemical+and+Biophysical+Research+Communications&dispmax=20&

dispstart=0

98 Lupus Nephritis

·
Nephrology, Dialysis, Transplantation : Official Publication of the

European Dialysis and Transplant Association - European Renal

Association. (Nephrol Dial Transplant)

http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ne

phrology,+Dialysis,+Transplantation+:+Official+Publication+of+the+Eur

opean+Dialysis+and+Transplant+Association+-

+European+Renal+Association&dispmax=20&dispstart=0

Vocabulary Builder

Antihypertensive:
An agent that reduces high blood pressure. [EU]

Nitrogen:
An element with the atomic symbol N, atomic number 7, and

atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78%

of the earth's atmosphere by volume. It is a constituent of proteins and

nucleic acids and found in all living cells. [NIH]

Prednisone:
A synthetic anti-inflammatory glucocorticoid derived from

cortisone. It is biologically inert and converted to prednisolone in the liver.

[NIH]

Preeclampsia:
A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is

called eclampsia. [EU]

Prenatal:
Existing or occurring before birth, with reference to the fetus. [EU]

Physician Guidelines and Databases 99

CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES

Overview

Doctors and medical researchers rely on a number of information sources to

help patients with their conditions. Many will subscribe to journals or

newsletters published by their professional associations or refer to

specialized textbooks or clinical guides published for the medical profession.

In this chapter, we focus on databases and Internet-based guidelines created

or written for this professional audience.

NIH Guidelines

For the more common diseases, The National Institutes of Health publish

guidelines that are frequently consulted by physicians. Publications are

typically written by one or more of the various NIH Institutes. For physician