Search Results for: skin lupus

• How is Lupus Diagnosed
• Types of Lupus
• Causes of Lupus
• Signs, Symptoms and Co-occuring conditions

Disease Overview

https://youtu.be/4PapRcayjxs

Lupus Signs & Symptoms

https://youtu.be/zJQGaXBuyuc

Diagnosing Lupus

https://youtu.be/oTMz-kLBj-Y

Treating Lupus

https://youtu.be/AkQD-dhqmZo

Lifestyle Considerations

https://youtu.be/bG7dNRgVF64

A complete urinalysis evaluates several different aspects of your urine through physical, chemical, and microscopic examination. In lupus treatment, a urinalysis is often used to monitor protein leakage and identify and assess urinary tract infections (UTIs). Most people with kidney lupus (lupus nephritis) will have an abnormal urinalysis. Protein, urine casts (especially red blood cell casts), red blood cells, or white blood cells in the urine can indicate serious kidney involvement; leukocyte esterase may indicate a bladder infection.

Urine samples can be given at any time while at the doctor’s office. A urine culture is performed to assess for a bladder infection and to determine appropriate antibiotics. Before giving a urine sample, ask a medical professional to counsel you on how to prevent contamination. Several analytical elements of the complete urinalysis are explained below.

Physical Examination / Macroanalysis

In this portion of the analysis, the color, clarity, and concentration of the urine are evaluated. Abnormal colors can result from disease, certain foods, or contamination, so the physical examination is generally viewed as a crude assessment. Light or dark coloration also suggests how much water is being excreted. The clarity of urine is measured as either clear, slightly clear, cloudy, or turbid. Urine clarity, like urine color, suggests that substances may be present in the urine; for example, turbid urine suggests the presence of protein or excess cellular material. However, accurate conclusions regarding the origin of the urine clarity cannot be drawn until further chemical and microscopic tests are performed. The physical examination also includes specific gravity, which measures the concentration of the urine sample. Specific gravity compares the concentration of urine to that of water (1.000). Usually it is better for the urine given in a sample to be more concentrated; this allows the laboratory to more accurately detect substances being excreted by your body. If your urine is very dilute (i.e., you have been drinking lots of water or receiving fluid via IV), you may be asked to give another urine sample.

Chemical Analysis

The chemical examination measures several features of the urine. Most laboratories use chemical test strips (“dipsticks”) that change colors when dipped into the urine. Either the laboratory technician or an automated instrument will then read the reaction color for each test pad to determine the result for each test. The use of automated instruments helps to eliminate discrepancies that arise with human interpretation.

• pH: Usually, the pH of urine is between 4.5 and 8.0. The kidneys regulate this acid-base chemistry by reabsorbing sodium and secreting hydrogen and ammonium ions. When the body retains excess sodium or acid, urine becomes more acidic (i.e., the pH is lower). Highly acidic urine can occur with uncontrolled diabetes, diarrhea, starvation, dehydration, and certain respiratory diseases. When your body retains excess base, your urine becomes more basic, or “alkaline” (i.e., the pH is higher). This can occur with urinary tract infections and certain kidney and lung conditions. Certain foods can also alter the pH of your urine. For example, eating excessive protein or cranberries can make your urine more acidic, whereas eating a low-carbohydrate or vegetarian diet can make your urine more basic. Sometimes people are asked by their doctors to regulate the pH of their urine through diet in order to manage certain diseases or medications. For example, kidney stones can occur if urine pH is too high or too low.
• Protein: Excessive protein in the urine (proteinuria) is a sign of kidney involvement in lupus. Usually, your kidneys prevent protein from passing from your blood into your urine: loops of capillaries (glomeruli) that filter blood allow small particles to pass into the urine while retaining larger particles, such as protein, and kidney tubules reabsorb the smaller proteins that were able to escape. Large amounts of protein in the urine suggest that these glomeruli and tubules are inflamed or damaged in some way.
• If there is a large amount of protein in the urine, your doctor may request that you give a 24-hour urine sample or obtain a random protein to creatinine ratio. These two tests are used to monitor lupus affecting the kidneys (lupus nephritis).
• Glucose: Your urine should not contain glucose. If it does, your doctor will order further bloodwork and urine tests to determine the cause. Glucose in the urine is called glucosuria; it can occur in people with diabetes that is not properly regulated with insulin, in people with kidney problems that affect the absorption of glucose, in pregnant women, and in people with liver abnormalities or hormonal disorders.
• Ketones: Ketones in the urine (ketonuria) indicate that your body is metabolizing its fat reserves instead of carbohydrates to obtain energy. This can occur in people on low-carbohydrate diets, people who are malnourished, or people who have a problem properly metabolizing carbohydrates (e.g., people with diabetes).  It can also occur with excessive exercise, loss of carbohydrates due to vomiting, or exposure to cold. In people with diabetes, ketonuria may indicate insufficient management with insulin.
• Blood: The chemical examination of urine also measures the amount of red blood cells in the urine sample. The presence of red blood cells in the urine is known as hematuria, and the presence of hemoglobin (from red blood cells) is known as hemoglobinuria. Usually people have very small amounts of red blood cells in their urine, but even a minute increase can indicate a problem, such as a disease of the kidney or urinary tract, trauma, medications, smoking, or intense exercise (e.g., running a marathon). When the chemical test for blood in the urine is negative but the microscopic assessment shows the presence of red blood cells, the laboratory will usually check for the presence of vitamin C, which can interfere with test results. [It is important to also note that contamination of the urine sample with menstrual blood or hemorrhoids cannot be distinguished from the presence of red blood cells in the sample. Therefore, it is very important to tell your physician if you are menstruating or are experiencing any other condition that could contaminate your urine sample. It is also very important that you speak to your lab technician about proper aseptic technique when giving a urine sample.]
• Leukocyte Esterase: Leukocyte esterase is an enzyme present in your white blood cells. Therefore, the presence of this substance in the urine indicates the presence of white blood cells (leukocyturia). White blood cells in the urine may indicate inflammation of the kidneys or urinary tract due to bacterial infection. It is important to note, however, that contamination of the urine can also cause the presence of white blood cells in the urine, so remember to practice proper aseptic technique when giving the sample.
• Nitrite: Bacteria can convert nitrate to nitrite; therefore, the presence of nitrite in the urine usually indicates a bacterial infection (i.e., a urinary tract infection). However, not all bacteria can convert nitrate to nitrite, so it is possible to have a urinary tract infection while also having a negative nitrite test.
• Bilirubin: Bilirubin is made by the liver from old red blood cells; it is then processed by the intestine and excreted from the body. Therefore, healthy individuals do not have bilirubin in their urine. The presence of bilirubin in the urine indicates that the liver is allowing the substance to leak back into the blood. This can be an early indication of liver disease, even when other symptoms, such as jaundice, are not present.

Microscopic Analysis

The microscopic examination uses a microscope to identify and count cells, crystals, bacteria, mucous, and other substances that may be present in the urine. The amount of a substance present is reported one of two ways: as a count with the microscope strength used to view the substance [“per low power field” (LPF) or “per high power field” (HPF)], or as an approximate amount (“rare,” “few,” “moderate,” or “many”).

• Red Blood Cells: The microscopic examination looks at how many red blood cells are present per HPF. As discussed above, the presence of red blood cells in the urine can indicate a problem, such as a disease of the kidney or urinary tract, trauma, medications, smoking, or intense exercise (e.g., running a marathon). However, contamination of the urine sample with menstrual blood or hemorrhoids cannot be distinguished from the presence of red blood cells in the sample. Therefore, it is very important to tell your physician if you are menstruating or are experiencing any other condition that could contamination your urine sample. It is also very important that you speak to your lab technician about proper aseptic technique when giving a urine sample.
• White Blood Cells: A high number of white blood cells in the urine indicates inflammation of the kidneys or urinary tract. Like the test for red blood cells, this test can be misread if the sample is contaminated; in this instance, contamination can occur from vaginal secretions, which are high in white blood cells. Therefore it is important that you speak to your lab technician about proper aseptic technique before giving a urine sample.
• Epithelial Cells: The tissue that lines the surfaces of cavities and structures in your body is called epithelial tissue. In healthy individuals, epithelial cells from the bladder and external urethra are normally present in the urine in small amounts.  However, the amount of epithelial cells in the urine increases when someone has a urinary tract infection or some other cause of inflammation. Your doctor will evaluate the source of the problem by evaluating the type of epithelial cells that are present. For example, the presence of renal tubular epithelial cells (from your kidneys) may indicate kidney involvement. The presence of squamous epithelial cells may indicate contamination of the urine specimen.
• Casts: Casts are formed in the tubules of they kidney when the tubules secrete a protein called Tamm-Horsfall protein. The origin of the casts causes them to take on a tubular or hotdog-like shape. These casts are known as hyaline casts and can be present in normal adults on the order of 0-5 per LPF. Strenuous exercise can cause more hyaline casts to be present.  However, casts made from red or white blood cells indicate problems in the kidney.  Red blood cells that stick together and form red blood cell casts usually indicate problems with the glomeruli, tiny ball-shaped structures in your kidneys that help filter blood and prevent the loss of valuable substances, such as blood cells and proteins. White blood cells casts indicate inflammation in the kidney. Cellular casts that remain in the nephron of your kidney for a long time before they are flushed out become granular casts and eventually waxy casts.
• Bacteria: Bacteria in your urine can suggest infection, especially if you have other suggestive symptoms. If your doctor suspects that you may have a urinary tract infection, she/he will most likely order a culture or count of the bacteria. However, bacteria on the skin can also contaminate the urine sample and skew the results, so it is very important that you understand proper aseptic technique when giving a urine sample.
• Crystals: Crystals can be present in the urine of healthy individuals; these crystals form when the pH, solute concentration, and temperature of your urine are within a specific range. If these crystals are made of substances that are supposed to be in urine, such as calcium oxalate or phosphate, then they are considered to be normal. Crystals made of substances that are not usually present in urine, such as cystine, tyrosine, or leucine (amino acids), are uncommon and usually indicate liver disease or some other abnormal process.

Sources

• “Urinalysis.” Lab Tests Online. 8 April 2009. American Association for Clinical Chemistry. 12 July 2009. <http://labtestsonline.org/understanding/analytes/urinalysis/sample.html>.

Clopidogrel (Plavix, Clopilet)
Ticlopidine (Ticlid)

What are antiplatelet medications, and why are they used in the treatment of lupus?

Clopidogrel (Plavix, Clopilet) and ticlopidine (Ticlid) are antiplatelet medicines (a.k.a., “platelet antagonists”) that help to prevent blood clots (thromboses). By preventing these clots, platelet antagonists help to prevent heart attack, stroke, and other complications. Lupus patients are at an increased risk for blood clots due to the prevalence of a condition known as antiphospholipid antibody syndrome (APS).  There are different kind of antiphospholipid antibodies, namely lupus anticoagulant, anticardiolipin antibody, and an antibody called anti-beta2 glycoprotein I. APS is also sometimes called Hughes Syndrome after the British doctor who first described it in the 1980s. Virtually 50% of lupus patients have antiphospholipid antibodies, but only 10% experience complications associated with APS, including miscarriages, stroke, and deep vein thrombosis (DVT). People who do not have lupus can also have antiphospholipid syndrome, but lupus patients comprise about 50% of people who have the condition. Aspirin is usually used to prevent APS, but other antiplatelet medications may also be used.

How should I take my antiplatelet medication?

Antiplatelet medications come in tablet form. They should be taken with a full glass of water, with or without food. If you miss a dose, take that dose as soon as you remember. However, if it is closer to the time you will take your next scheduled dose, simply wait until that time and take your normal dose—do not take extra medicine to make up for the dose(s) you missed.

What are the side effects of antiplatelet medications?

Since antiplatelet medications work to prevent platelets from clumping together to cause a clot, they may cause easy bleeding, even with minor injuries. If you experience bleeding that will not stop, you should get medical attention immediately. In addition, let your doctor know of any surgeries—including dental surgeries—that you intend to have, since you will most likely need to stop this medication before the procedure to prevent excess bleeding. Antiplatelet medications can also cause bleeding in your stomach or intestines, so tell your doctor if you have black or bloody stools or vomit that looks like coffee grounds.

What should I remember while taking this medication?

Do not drink alcohol or smoke while taking this medication. In fact, people who have lupus should do neither of these things, because they will only aggravate your symptoms and cause further damage to your heart, lungs, liver, kidneys, and other organs. In addition, usually people who take antiplatelet medications should not take NSAIDs or aspirin. However, your doctor may prescribe aspirin along with a platelet antagonist to treat your risk or clotting because the benefits of taking the medications together may outweigh the risks. It is important that you stick to the medications prescribed by your doctor and take them only as directed.

You should not take antiplatelet medications if you have a stomach ulcer. Make sure you also discuss with your doctor any history of blood clots, stroke, liver disease, or kidney problems. Also talk to your doctor if you are pregnant, may become pregnant, or are breastfeeding. Platelet antagonists are not harmful to an unborn baby, but it is not known yet whether they can be passed into breastmilk.

Warfarin (Coumadin)
Heparin
Dalteparin (Fragmin)
Danaparoid (Orgaran)
Enoxaparin (Lovenox)
Tinzaparin (Innohep)
Fondaparinux (Arixtra)

What are anticoagulants and why are they used in lupus treatment?

Warfarin (Coumadin) and heparin are anticoagulants (“blood thinners”), medications that decrease the ability of the blood to clot. About one-third of people with lupus have antibodies to molecules in the body called phospholipids. Sometimes these antiphospholipid antibodies (called anticardiolipin, lupus anticoagulant, or anti-beta2glycoprotein I) can lead to blood clots—thromboses—such as deep venous thrombosis, stroke, or heart attack.

A blood clot by itself is called a thrombus; a blood clot that breaks off and travels elsewhere in your circulatory (blood) system is called an embolus. It is rare for a blood clot to migrate to another part of the body and block one of your blood vessels, but if it does (a condition doctors call a thromboembolism), it is always serious. Blood clots can cut off circulation to your arms, legs, lungs (pulmonary embolism), brain (stroke), and heart (heart attack).

How do anticoagulants work?

Warfarin and heparin work in slightly different ways, but both block the production of certain proteins in your liver that work together to help your blood to clot. These proteins are called “cofactors.” Vitamin K controls the creation of these cofactors in your liver, and warfarin reduces clotting in your blood by preventing vitamin K from working correctly. Heparin also works by preventing certain cofactors, namely thrombin and fibrin, from working correctly. By blocking the process early on, both warfarin and heparin ultimately help to reduce blood clots from forming in your body.

How should I take these medications?

Warfarin comes in tablet form, and heparin must be given as an injection. The amount of medication needed differs with each person and each situation, and individuals on these medications should be closely monitored by their doctors to ensure that they are being given the correct dose.

Can I take these medications while I am pregnant?

Warfarin (Coumadin) is not safe during pregnancy. It can cause birth defects and fetal bleeding. Women who take warfarin must switch to heparin or low molecular weight heparin before they become pregnant, since heparin or low molecular weight heparin (Lovenox, Fragmin) do not cross the placenta into the fetus.

What should I remember while taking anticoagulants?

Do not smoke or drink alcohol while taking anticoagulants. Smoking increases the risk of blood clots and cardiovascular disease, and cardiovascular disease is the number one cause of death in people with lupus. Alcohol can interfere with the effectiveness of anticoagulant medications, can be harmful to your liver, and can irritate your stomach (gastritis), causing bleeding.

Warfarin

Warfarin is the most widely used anticoagulant, but because everyone differs in their physiological make-up, dosage requirements differ from person to person. Blood clotting is a natural protective mechanism employed by the body to seal off damaged blood vessels; any medication that alters this natural protective mechanism must be carefully monitored. People taking warfarin must obtain a blood test every 2-4 weeks to ensure that their blood is thinning to the correct degree without bleeding complications. This test (the INR, discussed below) may be requested several times a week at the beginning of your treatment to ensure that you are started on the correct dose.

The two tests used to monitor warfarin levels in the blood are the Prothrombin Time (or, just “Pro-Time,” or “PT”) and a test called an INR (International Normalized Ratio). In actuality, Prothrombin time is the test used, and INR is simply a standardized way for medical institutions to report consistent values for Prothrombin times. The INR ratio is calculated based on comparison of blood tests against a known standard, and your physician will monitor your warfarin levels based on this INR ratio. Generally, an INR of 2.5 to 3.0 indicates that the patient is receiving the correct dose of warfarin; INR values above 5.0 can be dangerous, and those below 1.0 indicate no warfarin effect.

Heparin

Heparin works faster than warfarin, so it is usually given in situations where an immediate effect is desired. For example, this medication is often given in hospitals to prevent growth of a previously detected blood clot. This medication is also recommended for pregnant women in whom antiphospholipid antibodies have been discovered, since warfarin can be harmful to an unborn child. However, when taken for long periods of time, this medication might increase the risk of osteoporosis. Usually patients switch to warfarin when long term anticoagulant treatment is recommended.

What are the potential side effects of anticoagulants?

The two most serious side effects of anticoagulants are bleeding and gangrene (necrosis) of the skin. Bleeding can occur in any organ or tissue. Bleeding in the kidneys can cause severe back pain and blood in the urine. Bleeding in the stomach can cause weakness, fainting, black stools, or vomiting of blood. Bleeding of the brain can cause severe headache and paralysis, and bleeding of the joints can cause joint pain and swelling.

Other side effects can include rash, bloating, diarrhea, jaundice (yellowing of the eyes and skin), hair loss, itchy feet, pain in the toes, and, in the case of heparin, mild pain, redness, or warmth at the injection site. Bleeding gums, excessive bruising, nosebleeds, heavy menstrual bleeding, and prolonged bleeding from cuts may indicate an overdosing of medication. Notify your doctor if these problems occur.

Some people receiving heparin have experienced a reaction to the infusion, so contact your doctor immediately if you experience any abrupt and serious side effects, such as sudden numbness, confusion, swelling, or trouble breathing.

What medications and foods should I avoid while taking anticoagulants?

While taking anticoagulants, you should avoid supplements with vitamin K. Remember that vitamin K controls the formation of proteins in your liver involved in clotting, so taking in vitamin K can work to counteract your medication and increase your risk of blood clots. In addition, you should avoid medications that can increase your risk of bleeding. These medications include aspirin, NSAIDs, multivitamins with vitamin K, and fish oil. Any antibiotic may change the Coumadin INR test. If you must take an antibiotic, notify your Coumadin clinic so that they may schedule an additional INR check. In addition, be sure to speak with your doctor before starting any new medications. Your physician may also recommend that you carry some sort of identification to alert health professionals of your use of anticoagulants should an emergency or other situation arise.