The Internet was buzzing yesterday after actress and singer Selena Gomez announced she’d undergone a kidney transplant earlier this summer. The procedure was prompted by the celebrity’s battle with lupus, an autoimmune disease. The picture of Selena and her donor and best friend, Francia Raisa, had people asking a lot of questions about the condition. We asked Fahd Saeed, MD, PPG – Rheumatology, to help us get a better understanding of how lupus affects the body, including symptoms and treatment.
In the simplest terms, lupus is your own body attacking your own body. For instance, if you were to receive an organ transplant, your body would recognize that organ is not your own and try to reject it. But with lupus, your body is rejecting its own organs. It’s trying to “get rid” of the organ.
Lupus doesn’t present through one particular symptom. It can present in many different ways, depending on the area of the body being affected. With skin lupus, it’s common to see a colored skin rash when someone is out in the sun, mostly on the sun-exposed areas, like the face, upper chest and arms, especially in summer. We’ll see a butterfly rash on the cheeks and bridge of the nose. This is the most common presentation.
If it’s also in the organs – the brain, lungs, kidneys, stomach, intestine – it can present in a lot of different ways. In the brain, we might see psychosis. If it’s in lungs, they can have shortness of breath and chest pain. In the heart, they might have palpitations and pain, or fluid around the lungs and heart. With lupus in the kidneys, like Selena has, we most commonly see signs of failure. Most commonly, they are not able to make urine, or we see blood in the urine.
There are several ways to diagnosis. If someone comes in with a history of lupus or we suspect lupus, we do a blood test and send it to the lab where they check for antibodies which are trying to destroy the body. Another way to diagnose is through urine testing. We’d be looking for blood or any damaged kidney cells in the urine.
If it’s on the skin, we can do a skin biopsy and send it to a pathologist to diagnosis. Similarly, if it’s elsewhere in the body, we can collect a biopsy and have it sent to a pathologist. This is the most accurate approach. Through a scope or by inserting a needle through the back, we get a sample of the organ to send in for testing.
If tests come back that it is lupus, then we do staging; Stage 1, 2, 3, 4, or 5. With lupus of the kidneys, for example, stage 1 and 2 are best. Stage 3 and 4 are not good, but there are treatment options. Stage 5 is complete kidney failure, meaning the biopsy showed complete damage.
With stages 1 through 4, there are medications available to stop the process. These immunosuppressant medications block the immune system so it will stop attacking the body. They make it so the body will stop making antibodies that attack the organs. Most people know these medications as chemo medications, because some are also used to treat cancer.
Depending on how bad the lupus is, the patient might take an immunosuppressant medication daily. If it looks worse, we would use a more aggressive medication. And if there’s nothing that can be done through medication, the person would be considered for a kidney transplant.
Lupus is not an incredibly common disease, affecting about 1 in 200 people. The disease is more common in African American and Hispanic populations.