Lupus Nephritis: Lupus and Kidney Disease

Lupus is an autoimmune disorder where the body’s immune system attacks its own cells, tissues and organs. Kidney damage is a common side effect. In adults who have lupus, 5 out of 10 will have kidney disease. Lupus nephritis is the term used to describe kidney damage caused by lupus.

Lupus nephritis may not cause symptoms at first. If you have lupus, it is important to get routinely tested for kidney problems. “​​Lupus nephritis occurs when lupus autoantibodies affect structures in your kidneys that filter out waste. This causes kidney inflammation and may lead to impaired kidney function or even kidney failure.” 

Signs and symptoms:

• Blood in your urine.
• Foamy urine (caused by the buildup of protein).
• High blood pressure.
• Swelling in your hands, ankles or feet.
• High levels of creatinine in your blood.

Lupus nephritis is diagnosed through a series of tests:

• Urine test: This test verifies blood or protein in your urine. A high level or protein (red blood cells) can indicate kidney damage.
• Blood test: This test measures your creatinine levels (the waste product from the normal breakdown of the muscles in your body). “Your kidneys remove creatinine from your blood. Health care professionals use the amount of creatinine in your blood to estimate your glomerular filtration rate (GFR). As kidney disease gets worse, the level of creatinine goes up.”
• Kidney biopsy: This procedure can confirm a lupus nephritis diagnosis, find out how far the disease has progressed and determine treatment needs.

Lupus nephritis tends to develop within 5 years of the initial lupus symptoms. It can lead to end-stage kidney disease in 22% of patients within 15 years. Effective and continual treatment is necessary. 

Medications that suppress the immune system are vital to stop the attack and damage to the kidneys. This is usually done with a corticosteroid such as prednisone. Medications to control your blood pressure may also be needed. Eating the right foods can help manage kidney disease.

A kidney biopsy can determine the stage of lupus nephritis:

• Stage 1: Minimal damage to the kidneys. No obvious signs or symptoms.
• Stage 2: Some kidney damage. Small amounts of blood or protein in the urine.
• Stage 3: Damage to less than 50% of the kidneys. 
• Stage 4: Damage to more than half the kidneys. High blood pressure. Will need dialysis.
• Stage 5: Thickening and scarring within the structures of the kidneys. Requires dialysis or a kidney transplant.
• Stage 6: Damage to more than 90% of the blood vessels in the kidneys. Dialysis and kidney transplant required.

“Currently, there is no cure for lupus nephritis. Treatment focuses on reducing inflammation and immune system activity to prevent further damage to the kidneys.”