CASE STUDY (Introduction)

“From the bitterness of disease man learns the sweetness of health.”

Everyone who has suffered some form of sickness or disease can reply with all certainty that good health is most sweet indeed. Most people realized how important a thing is once it’s already gone. This is perfectly seen in health. As we all know, health is very important to our life because it is in health where we achieve our optimal functioning as a being. It is in good health that we can do whatever we want. But due to modernization, we tend to abuse our health. We engage into different vices like smoking, drinking and worst is the use of prohibited drugs. And later we realized that even though we enjoy those things, we are only making our life shorter. And sometimes, we ignore those simple things without thinking that it might lead to bigger problem.

Systemic lupus erythematosus is a multisustem, inflammatory disorder associated with abnormalities of the immune system. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. It is a chronic condition characterized by various degrees of increased disease activity that are generally followed by a less active, remitting course. So many classic immunologic abnormalities can be present in SLE that is considered the prototype of an autoimmune disease. Typically, multiple body organs and systems are affected at different times, thus producing widespread damage to connective tissues, blood vessels and serous and mucous membranes (Black, 2009).

Lupus nephritis is a serious complication of systemic lupus erythematosus (SLE; lupus) and is a major predictor of poor outcome. Most commonly, lupus nephritis develops early in the course of disease, but it can be a late complication as well (called delayed lupus nephritis [DLN]). Mortality is higher for lupus patients who develop nephritis than for those who do not (http://www.arthritis.org/lupus-nephritis-predictors.php).

  

Early detection and treatment of kidney disease in lupus patients can lead to a longer and better-quality life since lupus is one of many autoimmune diseases that attack internal organs, tissues, joints and other parts of the body. The researchers focused on systemic lupus erythematosus affecting the kidneys, the most common and serious form of lupus. In an animal study, researchers found out that four proteins (protease, PGDS, SAP and SOD) in urine test might be able to detect early kidney disease in lupus patients. Their goal was to detect something in the urine that appears only in disease. This study, if proven to be effective in humans, might be able to predict, diagnose and monitor kidney damage noninvasively. In the current study, the researchers screened the urine for proteins of mice both before and after the mice showed symptoms of kidney disease and focused on four proteins that were present in high levels after symptoms appeared. These proteins or their analogs had not previously been known to be present in the urine of patients or mice with lupus kidney disease. Monitoring urinary levels of these four proteins might also reveal more about the mechanisms of lupus since each protein is involved in a different biochemical process, so the stage of the disease at which each appears in urine might prove informative. Testing for these proteins might also have the potential to monitor kidney damage that results from diabetes, hypertension and other conditions (http://www.sciencedaily.com/releases/2010/02/100216101208.htm).

SLE is primarily a disease of young women. Peak incidence occurs between the ages 15 and 40 during childbearing years, with a female to male ratio of 5:1. However, the onset can range from infancy to advanced age. In both pediatric and older-onset clients, the female to male ratio is 2:1 (Black, 2009). Prevalence is 1.5 million Americans suffer from Lupus that is 1 out of every 200 Americans. Lupus affects African Americans three times more commonly than Caucasians. Asians, Hispanics, and Native Americans are also more commonly affected. 20% of people with Lupus will have a close relative (parent or sibling) who already has Lupus or may develop Lupus (http://cure4lupus.org). Estimates of the prevalence of clinical renal involvement in persons with SLE range from 30-90% in published studies. The true prevalence of clinical lupus nephritis in persons with SLE is probably around 50%, being more common in certain ethnic groups and in children (http://emedicine.medscape.com/article/330369-overview). Locally, the prevalence of lupus in the Philippines is 443,891 among the population of 86,241,697 wherein the word prevalence of lupus usually means the estimated population of people who are managing lupus at any given time. This statistics is based on an article entitled “Statistics by Country for Lupus”.

While lupus is a very common condition, many people are not aware of what it is and what can be done to treat it. With this case report, researchers and readers will learn more regarding the nursing and medical treatment of lupus nephritis that they can incorporate in their nursing practice. Knowing the possible outcomes and other complications of SLE, nurses and nursing students can plan and improve nursing care given to the patients. Awareness is the main reason in choosing the case. There is a survey that only 18 percent of women are personally concerned about lupus. The majority of respondents expressed concern about other health-related conditions, including cancer (67%), depression (61%), high blood pressure (58%), diabetes (57%) and arthritis (52%). Furthermore, approximately 29% could not correctly define lupus as an autoimmune disease, and 31% were not aware that women of childbearing age are most at risk. 50% of Lupus patients see at least 3 doctors, over at least 4 years before being diagnosed. In a nationwide poll of 1,000 adults conducted for the Lupus Foundation of America, 61% said they knew little to nothing about Lupus (http://cure4lupus.org).

(Last November 10, 2010, I submitted a case study about Lupus Nephritis. Our clinical instructor gave us the chance to choose a topic of interest. When we're having our orientation, I got interested when I saw the diagnosis "LUPUS NEPHRITIS" written on the white board. It was a challenge for me but at the same time, I enjoyed doing this case study. It was easy for me to understand since other tests were performed to me already. Hopefully, I can summarize or give you random facts about lupus someday and I'll post them in bulleted form.)