Lupus Q&A: Cook Children’s Nephrologist Answers Common Questions
Lupus is a chronic (long-term) disease that can cause inflammation and pain in any part of your body. Because lupus affects many parts of the body, it can cause a lot of different symptoms and no two cases are exactly alike. Pediatric nephrologist Celina Cepeda, M.D., addresses commonly asked questions about lupus and treatment.
What is lupus?
Lupus is a chronic autoimmune disease where a person’s immune system (the system that helps fight infections) attacks its own healthy cells by mistake. It can affect different organs of the body, including, but not limited to the skin, joints, heart, kidneys, and lungs. It usually occurs without warning and affects each person differently. Unfortunately, we don’t know the exact cause of the disease, but we know the immune system is involved; genetics, hormones, and the environment also likely play a part.
What are the signs and symptoms of lupus?
Its symptoms can mimic those of other diseases, which is why it’s known as “the great mimicker.” The intensity of symptoms varies and can come and go over time, but the most common include:
- Hair Loss
- Joint pain, stiffness and swelling
- Butterfly-shaped rash across cheeks and nose
- Abnormal blood clotting
- Pain in chest or deep breathing
- Sun or light-sensitivity
- Fingers and toes that turn white or blue when exposed to cold or during stressful periods
Who develops lupus?
Anyone from newborn babies to older individuals can develop lupus. It is most often diagnosed between the ages of 15 and 45 and is more common among African Americans, Hispanics, Asian Americans, Pacific Islanders and Native Americans.
Lupus is also more common in women.
How is lupus diagnosed?
There is no single test that can diagnose lupus.
Because lupus can present with vague symptoms and mimic other illnesses, it can sometimes take years to make a diagnosis. Medical history, symptoms, and various tests can help make the diagnosis. Instead, diagnosis is based on criteria that includes clinical findings and laboratory tests. Helpful tests look for autoantibodies (antibodies that attack a person's healthy cells) that are often found in the blood of lupus patients. As the kidneys are often affected by lupus, a kidney biopsy is also useful.
How does lupus affect the kidneys?
When the immune system attacks the kidneys, it leads to inflammation of the kidneys. This stops the kidneys from working properly to remove waste and toxins from the body. Patients may not have any symptoms but may notice darker, bloody urine or swelling in different parts of the body. An abnormal urine or blood test may be the only sign of disease. Because the kidneys are so important to overall health, lupus patients with kidney involvement generally need strong drug treatment to help prevent permanent damage. If permanent damage does occur, dialysis and kidney transplant are needed.
How is lupus treated?
There is no cure for lupus, but there are various treatment options to manage it. Non-steroidal anti-inflammatory drugs, steroids, antimalarials, and immunosuppressants are commonly used. As lupus affects patients differently, treatment varies between patients. One patient may also have to change medications several times during their lifetime as the disease evolves and changes. For patients with kidney involvement, blood pressure medications and stronger immunosuppressants may be needed.
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I am from Brownville, Texas, down in the Rio Grande Valley. When I was in high school, I thought about being a pharmacist to follow in my father's footsteps. However, it wasn't until college – after dissecting a cow eye - I decided to pursue a medical degree. My sophomore year of college, I applied for and was accepted to the Early Medical School Selection Program from Boston University while at University of the Incarnate Word. After graduating with a Bachelor of Science in biology, I attended Boston University School of Medicine. I enjoyed most of my medical school clinic rotations, but during my pediatric rotation in medical school, I felt like I connected well with children and they seemed comfortable around me, so this is when I decided being a pediatrician was for me.
Did I ever think I would be a pediatric nephrologist? Nope. In medical school, the kidneys were one of the more complicated organs to learn about so being a physician working with the kidney system was not on my radar ... until my pediatric nephrology rotation during residency. Being exposed not just to electrolyte issues, but also issues like urinary tract infections, kidney stones, and high blood pressure made me more interested in the field. What I love about this field is the relationships that are built with patients and their families. Unfortunately, kidney problems can be chronic in nature, so I do see patients on a long-term basis; this allows me to build long-lasting, trusting, compassionate connections. Also, being able to get patients with chronic kidney disease and end-stage kidney disease to kidney transplant is very satisfying and such a joyous moment for myself, my patients and their families.
Before joining Cook Children's, I was in a private practice and at Medical City Children's Hospital in Dallas for 3 years. I am so happy to join Cook Children's and look forward to taking care of you.
In my spare time I enjoy spending time with my fur baby – a Chihuahua mix. I also enjoy volunteering at the SPCA of Dallas, working out and lifting weights, traveling, going to comedy shows, and relaxing at home. In addition to English, I speak Spanish.