What Is Lupus Nephritis?
Systemic lupus erythematosus (SLE) is commonly called lupus. It’s
a condition in which your immune system begins attacking different areas of
Lupus nephritis is one of the most serious complications of
lupus. It occurs when SLE causes your immune system to attack your kidneys. Specifically,
the parts of your kidney that filter your blood for waste products.
The kidneys play a vital part in your body’s functioning. They
remove waste from your blood. If they’re damaged, you can become very ill.
People with damaged kidneys might have to get regular hemodialysis. This is a
procedure in which your blood is cleaned by a filtration machine. People with
lupus nephritis even need a kidney transplant.
What Are the Symptoms of Lupus Nephritis?
Lupus nephritis symptoms are similar to those of other kidney
diseases. They include:
- dark urine
- blood in urine
- foamy, frothy urine
- having to urinate often, especially at night
- puffiness in the feet, ankles, and legs that
worsens over the course of the day
- gaining weight
- high blood pressure
Diagnosing Lupus Nephritis Diagnosed
One of the first signs of lupus nephritis is blood in your urine
or extremely foamy urine. High blood pressure and swelling in your feet also might
indicate lupus nephritis. Tests that will help your doctor make a diagnosis
include the following:
Your doctor will look for elevated levels of waste products, such
as creatinine and urea. Normally, the kidneys filter out these products.
24-Hour Urine Collection
This test measures the kidney’s ability selectively to filter
wastes. It determines how much protein appears in urine over 24 hours.
Urine tests measure kidney function. They identify levels of:
- red blood cells
- white blood cells
Iothalamate Clearance Testing
This test uses a contrast dye to see if your kidneys are
Radioactive iothalamate is injected into your blood. Your doctor
will then test how quickly it’s excreted in your urine. They may also directly
test how quickly it leaves your blood. This is considered to be the most
accurate test of kidney filtration speed.
Biopsies are the most accurate and also most invasive way to
diagnose kidney disease. Your doctor will insert a long needle through your stomach
and into your kidney. They’ll take a sample of kidney tissue to be analyzed for
signs of damage.
Ultrasounds use sound waves to create a detailed image of the
kidney. Your doctor will look for anything abnormal in the size and shape of your
Stages of Lupus Nephritis
After diagnosis, your doctor will want to determine the severity
of your kidney damage. The World Health
Organization (WHO) developed a system to classify the five different stages
of lupus nephritis.
- Stage 1
means there’s no evidence of lupus nephritis.
- Stage 2
is the mildest form, and it’s easily treated with corticosteroids.
- Stage 3
is the earliest stage of advanced lupus. Treatment requires high amounts
of corticosteroids. The outlook remains favorable.
- Stage 4
is an advanced stage of lupus. There’s a risk of kidney failure. People
with lupus nephritis in this stage require high amounts of corticosteroids and
immune suppression medications.
- Stage 5 involves
excessive protein loss and swelling. Your doctor will treat this with high
amounts of corticosteroids. They may or may not give you drugs that suppress
your immune system.
Treatment Options for Lupus Nephritis
There’s no cure for lupus nephritis. The goal of treatment is to
keep the problem from getting worse. Stopping kidney damage early can prevent
the need for a kidney transplant.
Treatment can also provide relief from lupus symptoms.
Common treatments include:
- minimizing your intake of protein and salt
- taking blood pressure medication
- using steroids to reduce swelling and
- taking medicines to suppress your immune system
such as prednisone, which reduces immune system damage to the kidneys
Extensive kidney damage may require additional treatment.
Complications of Lupus Nephritis
The most serious complication associated with lupus nephritis is
kidney failure. People with kidney failure will need either dialysis or a kidney
Dialysis is usually the first choice for treatment, but it will
not work indefinitely. Most dialysis patients will eventually need a
transplant. However, it may take months or years before a transplant becomes
Long-Term Outlook for People with Lupus
The outlook for people with lupus nephritis varies. Most people
see only intermittent symptoms. Their kidney damage may be noticed only during
If you have more serious nephritis symptoms, you’re at increased
risk for a loss of kidney function. Treatments can be used to slow the course
of nephritis, but they aren’t always successful. Talk to your doctor about
which treatment is right for you.