Then she was rushed to the hospital with sky-high blood pressure and severely swollen ankles and face. She had gained about 40 pounds in less than two weeks.

"I was pretty much out of it," Emily said.

She had acute kidney failure caused by the autoimmune disease systemic lupus erythematosus. Her immune system was out of control. She was referred to Anitha Vijayan, MD, Washington University nephrologist at Barnes-Jewish Hospital.

Most of the estimated 1.5 million Americans with lupus have only mild symptoms – fatigue, achy joints and skin rash. Rheumatologists usually manage these patients. Of patients with more severe systemic lupus, 50 – 60 percent develops kidney involvement. Kidney involvement carries the highest mortality rate of any lupus complication necessitating aggressive treatment and ongoing management by a kidney specialist.

Dr. Vijayan began Emily on a protocol of intravenous immunosuppressant medication and prednisone to curb her out-of-control immune system, as well as medications to control blood pressure and reduce protein spilling by the kidney.

Young women undergoing this protocol must be carefully managed to preserve their fertility, Dr. Vijayan said. However, they must also have adequate birth control because some medications can be toxic to a fetus.

"In addition, pregnancy can aggravate lupus symptoms and renal disease, especially if the patient is having active disease," she said.

Though the treatment could be grueling, Emily was a model patient.

"She had a supportive family," Dr. Vijayan said. "She and her mother were very compliant with the medications and physician visits. They recognized the severity of the disease and were determined to do everything to get better."

As a result, Emily is in complete remission. Her weight and blood pressure are normal. Her kidneys are functioning and she feels good.

"I still get tired really easily," she said. "But for the most part, I do really well."

She sees Dr. Vijayan every four or five months and will always be vigilant about looking for signs that she may be having a lupus flare.

She started chiropractic college one year following her diagnosis. She''s looking forward to graduating soon and beginning work, maybe even helping other lupus patients like herself.