Lupus nephritis
Nephritis - lupus; Lupus glomerular disease
Lupus nephritis, which is a kidney disorder, is a complication of systemic lupus erythematosus.
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.
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:
When your joints are sore and achy, you might assume you have arthritis. But if that joint pain strikes when you're still in your 30's, or even your 20's, it might be another condition entirely. You might have an autoimmune disease called systemic lupus erythematosus, or lupus, for short. An autoimmune disease means that your immune system, which normally serves as your body's first defense against infections, mistakenly attacks your own tissues. Imagine if you hit your hand over and over and over again. The skin would turn red and swell up, and it would probably hurt quite a bit. Well, the same kind thing happens inside your body when your immune system attacks your tissues. They swell up, and they hurt. Almost everyone with lupus has joint pain and swelling, but depending on what part of your body the lupus is attacking, you could have other symptoms too. If it's your skin, you might have a rash on your face and body. If lupus attacks your digestive tract, you might feel sick to your stomach. If it attacks your brain or nervous system, you may have numbness, tingling, vision problems, and headaches. So, how do you know that you have lupus? Your doctor will ask about your symptoms, listen to your heartbeat, and examine your nervous system. Doctors often use a test to check for antinuclear antibodies, the immune substances that attack your tissues. You'll likely also need other blood or urine tests, and perhaps an x-ray, CT, ultrasound or biopsy, depending on your symptoms. Taken together, your symptoms and the results of these tests can help your doctor determine whether you have lupus. If you do have lupus, lupus is a chronic condition, but, you can control its symptoms. For example, taking steroid medicines by mouth might help control the overactive immune response that's causing your lupus. Steroid creams can treat skin rashes. For achy joints, non-steroidal anti-inflammatory medicines like ibuprofen, and anti-malaria drugs might help. You may need stronger drugs if these medicines alone don't control your lupus symptoms. When you have lupus, you need to be extra careful about your health. Wear sunscreen and protective clothing whenever you're out in the sun, so your skin doesn't get even more irritated. Stop smoking and make sure you're up-to-date on your vaccines. Have your heart checked regularly because lupus can cause heart complications. Lupus can be a lifelong journey, but life with lupus is a lot better today than it was just a few decades ago. Improved treatments can help control your joint pain and other symptoms so you can live a pretty normal life. To improve your outlook with lupus, stay on top of your health care, and do call your doctor right away if your symptoms get worse or you develop any new symptoms.
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
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.
Version Info
Last reviewed on: 8/28/2023
Reviewed by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
