Lupus nephritis
Definition
Lupus nephritis, which is a kidney disorder, is a complication of systemic lupus erythematosus.
Alternative Names
Nephritis - lupus; Lupus glomerular disease
Causes
Systemic lupus erythematosus (SLE, or lupus) is an autoimmune disease. This means there is a problem with the body's immune system.
Normally, the immune system helps protect the body from infection or harmful substances. But in people with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. As a result, the immune system attacks otherwise healthy cells and tissues.
SLE may damage different parts of the kidney. This can lead to disorders such as:
Symptoms
Symptoms of lupus nephritis include:
- Blood in the urine
- Foamy appearance to urine
- Swelling (edema) of any area of the body
- High blood pressure
Exams and Tests
Your health care provider will perform a physical exam and ask about your symptoms. Abnormal sounds may be heard when the provider listens to your heart and lungs.
Tests that may be done include:
- ANA titer
- BUN and creatinine
- Complement levels
- Urinalysis
- Urine protein
- Kidney biopsy, to determine appropriate treatment
Treatment
The goal of treatment is to improve kidney function and to delay kidney failure.
Medicines may include drugs that suppress the immune system, such as corticosteroids, cyclophosphamide, mycophenolate mofetil, or azathioprine.
You may need dialysis to control symptoms of kidney failure, sometimes for only a while. A kidney transplant may be recommended. People with active lupus should not have a transplant because the condition can occur in the transplanted kidney.
Outlook (Prognosis)
How well you do depends on the specific form of lupus nephritis. You may have flare-ups, and then times when you do not have any symptoms.
Some people with this condition develop long-term (chronic) kidney failure.
Although lupus nephritis may return in a transplanted kidney, it rarely leads to end-stage kidney disease.
Possible Complications
Complications that may result from lupus nephritis include:
When to Contact a Medical Professional
Contact your provider if you have blood in your urine or swelling of your body.
If you have lupus nephritis, contact your provider if you notice decreased urine output.
Prevention
Treating lupus may help prevent or delay onset of lupus nephritis.
References
Hahn BH, McMahon M, Wilkinson A, et al. American College of Rheumatology guidelines for screening, case definition, treatment and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64(6):797-808. PMCID: 3437757 www.ncbi.nlm.nih.gov/pmc/articles/PMC3437757/.
Malvar A, Alberton V, Rovin BH. Lupus nephritis. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 27.
Radhakrishnan J, Stokes MB. Glomerular disorders and nephrotic syndromes. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 107.