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:

• Interstitial nephritis
• Nephrotic syndrome
• Membranous glomerulonephritis
• Kidney failure

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

The 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:

• Acute renal failure
• Chronic renal failure

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.

Wadhwani S, Jayne D, Rovin BH. Lupus nephritis. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 26.