Brief Answer:
SLE with nephropathy -post renal transplant

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Since you have SLE since 12 years of age and now you are 32 years old,it is not surprising ,you had advanced kidney disease/ ESRD (End stage renal disease) following Lupus nephritis and had to undergo kidney transplant.

Post-transplant you are under immuno-suppressive therapy to reduce the risk of acute rejection.
You are under the most frequently used combination of triple therapy with prednisolone, a calcineurin inhibitor (e.g tacrolimus 2.5 mg) and an antimetabolite (e.g Mycophenolate mofetil/MMF) and bactrim (prophylaxis for Pneumocystis jiroveci pneumonia) while under immuno-suppression.

The drugs are given as per body weight.
You are having post-operative diuresis (output 4.6 L/day) and you need adequate fluid and electrolyte balance. Your nephrologist is competent enough to handle this.Kindly follow his advice.
Recovery usually occurs within 3 weeks.

Most chronically uremic patients have some excess of extracellular fluid (still having little swelling in the legs), and it is useful to maintain an expanded fluid volume in the immediate postoperative period.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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Brief Answer:
SLE and disease activity markers

Detailed Answer:
Your ANA and ds DNA are at present negative indicating remissions.


However there is no cure for SLE, and complete sustained remissions are rare.

Lupus nephritis occurs in approximately 10% of transplanted kidneys.

Hence you are likely to remain free of renal problems in future.

Titer of Antinuclear Antibody (ANA)does not correlate with disease activity.     


Titres of anti-dsDNA vary over time.
Titer generally correlates with disease activity.
Since it is negative,it indicates remission of disease activity but you are under immuno-suppressive therapy.
Remission may last for quite some-time but flares following remission are not uncommon with rise in titre of auto-antibodies (ANA,ds DNA etc) and require diligent follow-up.

Consult your rheumatologist.

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Brief Answer:
Renal diet

Detailed Answer:
Your diet should contain adequate protein as the protein requirement in chronic renal failure 0.8 g/kg of body weight /day e. g if you are 60 kg, requirement is approximately 50 G/day.

You can take 1 boiled egg (1 egg=35 G protein) with breakfast .

You can take also Curd-1/4th cup (50 ml) with lunch and 1/4th cup (50 ml) with dinner .
You can take also Dal as source of protein.

Milk or badam milk as you prefer can be taken ½ cup (100ml)      with breakfast and mid-morning(10 AM), and 75 ml at tea-time in the afternoon.

Since your potassium is on higher side/high normal.you should avoid high potassium diet e.g potato,sweet potato,sword bean.drumstick.

You can take fruit of low potassium content e.g apple, guava, papaya,pine- apple-once/twice a week 10 g at a time.
This is a standard dietary advice.

However you need to consult a dietitian to customize your diet.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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