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What is lupus nephritis?
There are two types of lupus. Systemic lupus erythematosus (SLE) is the form of lupus that can harm your skin, joints, kidneys and brain and may be fatal. The other form of lupus is called “discoid” lupus erythematosus, which affects only your skin. Systemic lupus erythematosus (SLE) that affects the kidneys is called lupus nephritis. Lupus is an “autoimmune” disease. With lupus, the body’s immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys.

Up to 60% of lupus patients will develop lupus nephritis. When the kidneys are inflamed, they can’t function normally and can leak protein. If not controlled, lupus nephritis can lead to kidney failure.

What causes lupus nephritis?
No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants (car fumes, factory smoke) may play a role in causing the disease. Men and women of all ages and races get lupus. However, about 90 percent of people diagnosed with lupus are women.

What are the symptoms of lupus nephritis?
Lupus nephritis can cause many signs and symptoms and may be different for everyone. It is a serious problem. Its symptoms, though, are not always dramatic Signs of lupus nephritis include:

  • Blood in the urine (hematuria)
  • Edema
  • Weight gain
  • High blood pressure
  • Dark urine
  • Foamy, frothy urine
  • The need to urinate during the night

Not all urinary or kidney problems in people with lupus are due to lupus nephritis. People with lupus may also be prone to urinary tract infections. These cause burning on urination and require treatment with antibiotics.

What tests are done to find out if I have lupus nephritis?
Your doctor will do a physical examination, get your medical history, and do special tests. These tests include:

  • Urine test to check for protein and blood
  • Blood tests
    • Check your levels of protein and cholesterol
    • Check your GFR (glomerular filtration rate) to show how well your kidneys are filtering wastes
    • Check for antiphospholipid antibodies and antinuclear antibodies (ANA) at least once during your disease.
  • Kidney biopsy to look at a tiny piece of the kidney under a microscope

How is lupus treated?
Lupus is treated with drugs that block your body’s immune system. These include drugs like steroids (corticosteroid) and antimalarial drugs. Everyone is different and your doctor will make a treatment plan that is right for you. Usually, treatment for lupus nephritis include:

  • Corticosteroids (often called “steroids”)
  • Immunosuppressive drugs
  • ACE inhibitors and ARBs
  • Diuretics
  • Diet change

Even with treatment, loss of kidney function sometimes progresses. If both kidneys fail, people with lupus nephritis may need dialysis. Dialysis involves filtering the blood through a machine to remove waste products from the body.

Ultimately, it may be necessary to have a kidney transplant. In those cases, people will need additional drugs to keep their immune system from rejecting the transplanted kidney

Do these treatments have side effects?
You should always speak with your doctor about the risks and benefits of any of the treatments you receive. Each of the drugs during any of these treatments can have their own side effects. Fortunately, these side effects usually are manageable for most patients. Discuss your treatment with your healthcare provider. Your overall health and the health of your kidneys should always be considered. There are times when the side effects of certain treatments are not worth the risk to your health.

If you are a woman with lupus nephritis and want to have children, you should discuss with your healthcare provider the effect your treatment may have on that process. There are ways to make sure that treatment is less harmful to this process.

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