What Is POTS??

What Is POTS??

Saturday, March 3, 2018

White blood cells, Sjogren's Syndrome Lupus and Renal Tubular Acidosis

Monocytes are a type of white blood cell developed in bone marrow and matured in the blood.They are called phagocytic because they are a type of cell capable of engulfing and absorbing bacteria and other small cells and particles. They have receptors on them to detect bacteria or other foreign matter. After they attack and engulf bacteria they go to lymph glands and display the remains to the lymphocytes so that the immune system then recognizes it as an invader.
Phagocytes also are important in apoptosis. Apoptosis is when a cell either dies from natural causes or from some injury or disease. When a cell dies phagocytes get rid of them by absorbing them the same way they do foreign cells. One of the effects of Lupus is premature apoptosis of cells.
There should be a balance between cells dying and new cells being created. But with lupus, the balance is off. This plays into why people with SLE have anemia and bleeding issues.

Phagocytes can communicate with other cells by producing chemicals called cytokines, which recruit other phagocytes to the site of infections or stimulate dormant lymphocytes.

Whereas phagocytes attack any invader, lymphocytes make antibodies against specific invaders.

Sjogren's Syndrome is caused by infiltration of monocytes and B-lymphocytes in epithelial glandular and extra-glandular tissues. I think this infiltration refers to the fact that monocytes are usually in the tissue of the body somewhere. They will move from one place to another in the body through the bloodstream, but usually don't stay in the blood.

When Sjogren's patients have kidney involvement, it can cause renal tubular acidosis type I (RTA I), tubulointerstitial nephritis, diabetes insipidus (DI), nephrolithiasis, and Fanconi syndrome.

For the purpose of understanding, monocytes are white blood cells that are embedding in certain cells and because they are phagocytes, the cause cell damage in organs. In the case of Sjogren's, it is the epithelial cells on the outside of blood vessels and organs. They are there to be a protective layer, for secretion or absorption or sensing. All glands are made of epithelial cells.

So if a salivary gland is infiltrated, it would become damaged and eventually not be able to secrete saliva.

The inability of the kidney either to excrete sufficient net acid or to retain sufficient bicarbonate results in a group of disorders known as renal tubular acidosis RTAs. RTA is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine.

As in Sjogren's Syndrome, RTA in SLE Lupus is rare. If it is present, it likely represents the consequence of significant tubulointerstitial damage, which should signal the need for rapid treatment of the underlying lupus nephritis to avoid future renal insufficiency.

In the setting of a hyperkalemic normal anion gap metabolic acidosis and a urine pH less than5.5, the clinician should have a high index of suspicion for the presence of type 4 RTA.
Conversely, a diagnosis of incomplete type 1 RTA may be entertained in patients with hyperkalemia
and a urine pH which is persistently greater than 5.5.

The word acidosis refers to the tendency for RTA to cause an excess of acid, which lowers the blood's pH.  When the blood pH is below normal (7.35), this is called acidemia. The metabolic acidosis caused by RTA is a normal anion gap acidosis.

White blood cells can create antibodies that attach to bits of your DNA from a worn out cell. This attached pair is called an immune complex. It can lodge in your kidney and cause inflammation.Thisis called lupus nephritis.

High monocytes indicate autoimmune activity or infection.

Low levels of lymphocytes or lymphocytopenia is also an indication of
autoimmune activity or infection. In Lupus, it is caused by the body making antibodies against lymphocytes.

Low albumin is also associated with chronic inflammation.
Low albumin is also commonly seen when the kidney leaks protein in the urine when it is
inflamed in lupus (nephritis).

Low platelets are a symptom of lupus too.(https://www.lupusuk.org.uk/wp-content/uploads/2015/10/8.-Blood-Disorders.pdf)

Symptoms of RTA include:

  • Gastrointestinal problems like, decreased appetite, vomiting and abdominal pain
  • Vasodilation of peripheral arterioles which can cause shock
  • Urine that is more alkaline than normal, which causes hypercalciuria, calcium oxylate in the urine and kidney stones. 
  • hyperchloremia

Regardless of whether it is SLE or SS that causes RTA, steroids, and immunosuppressants
are the treatment.







How Lupus Attacks Immune System? - Manipal Hospital

Apoptosis and Microparticles in the Origination and Development of Lupus