Males and Lupus
Systemic lupus erythematosus (lupus) is a disease that mainly affects women of childbearing age. It is impressive that for every 9 women affected by lupus there is only 1 man with the disease. Although, people have speculated that this preference for females is due to hormonal factors, the X chromosome, etc., the cause of the discrepancy is not clear.
Lupus is notorious for its capacity to affect all organs in the body, including the kidney. Kidney inflammation due to lupus is called lupus nephritis. Patients with lupus nephritis often come to the doctor because of other symptoms of active lupus such as fevers, malaise, arthritis, skin rash etc., or because of fluid retention, especially in their legs and feet. In more severe cases, they may also have swelling around their eyes, and in their stomach. Their blood pressure is often high and their urine often shows some blood and excess protein. The high protein makes the urine appear foamy. The diagnosis often requires a consultation with a nephrologist and a kidney biopsy.
Lupus nephritis occurs in up to 50% of patients with lupus. It is a serious condition that even if successfully treated, it may recur. Lupus nephritis, if not treated promptly and aggressively, may lead to irreversible kidney scarring. In up to 20% of patients the scarring is severe and leads to hemodialysis or need for kidney transplantation.
The current standard of care for lupus nephritis includes medications such as corticosteroids (i.e. prednisone), and either cyclophosphamide or mycophenolate mofetil (Cellcept) for the first few months of treatment. After disease control is achieved, we use either mycophenolate mofetil or azathioprine along with low dose of corticosteroids to keep the disease quiet. Although these treatments are generally effective, they are far from optimal, and therefore the lupus community is hoping to get better treatments by conducting clinical trials.
Males with lupus nephritis
We do not have good information on males and lupus nephritis. The data are mostly from reviews of patient records. Nevertheless, it appears that males with lupus get lupus nephritis more often than females with lupus. In addition, males with lupus nephritis have more severe disease than females with lupus nephritis. In other words, more men than women with lupus nephritis may end up requiring hemodialysis or kidney transplantation. So although more women than men get lupus, it’s the men that develop lupus nephritis more often and with more severity.
It is not clear what causes men to get more nephritis and more severe nephritis. Potential causes may be genetic factors, compliance with visit to doctors and with medications, smoking, and other coexisting diseases such as hypertension.
In conclusion, men with lupus need to see their rheumatologists regularly and if they develop lupus nephritis, they should be treated as soon as possible, in order to achieve the best possible outcomes. They should keep their blood pressure and lipids under control, avoid salt, avoid exposure to the sun and quit smoking.
Dr. Kyriakos Kirou is a physician-scientist in the field of academic rheumatology. Dr. Kirou is the Clinical Co-Director of the Mary Kirkland Center for Lupus Care.