Lupus Nephritis

Overview

What is lupus nephritis?

Lupus nephritis is inflammation and damage in your kidneys due to systemic lupus erythematosus (SLE). SLE is the most common form of lupus. Lupus is an autoimmune disease that triggers your immune system to attack your tissues. In addition to your kidneys, lupus can damage your brain, heart, joints, skin and other parts of your body.

Lupus nephritis prevents your kidneys from:

  • Controlling blood pressure and blood volume.
  • Filtering wastes out of your blood.
  • Maintaining the right levels of body fluids, including salts, acids and minerals.
  • Regulating hormone levels.

It can lead to a variety of serious health problems, including kidney failure and end-stage renal disease.

Who gets lupus nephritis?

Only adults and children with lupus can develop lupus nephritis. You’re more likely to get lupus if you:

  • Are a woman (9 out of 10 people with lupus are women) between the ages of 15 and 44, though men are more likely to develop lupus nephritis.
  • Are of Black, Native American, Hispanic/Latino, Pacific Islander or of Asian descent.
  • Come in contact with certain infections, viruses, toxic chemicals or pollutants in the environment.
  • Have a family history of the disease.
  • Have another autoimmune disease.

How common is lupus nephritis?

About 50% of adults with lupus will develop lupus nephritis. About 80% of children with lupus will develop this kidney condition.

Symptoms and Causes

What causes lupus nephritis?

In lupus nephritis, your body attacks your kidney, which leads to inflammation and abnormal kidney function. Long-term inflammation leads to scarring and permanent kidney damage.

What are the symptoms of lupus nephritis?

Symptoms of lupus nephritis tend to develop about five years after lupus symptoms first appear. But lupus nephritis can be the first — and sometimes the only — manifestation of systemic lupus erythematosus (SLE). Lupus nephritis can cause:

  • Edema (swelling due to fluid buildup) in your lower body or around your eyes.
  • Fever with no known cause.
  • Hematuria (blood in the urine).
  • High blood pressure.
  • Increased urination, especially at night.
  • Joint pain or swelling.
  • Muscle pain.
  • Proteinuria (protein in the urine), which often causes your urine to look foamy.
  • Red skin rash on the face.
  • Weight gain due to excess fluid in your body.

Diagnosis and Tests

How is lupus nephritis diagnosed?

Your healthcare provider performs a physical examination, reviews your symptoms and evaluates your medical history. Blood and urine tests to detect lupus nephritis include:

  • Antibody blood tests check for high levels of proteins made by your immune system.
  • Labs to assess kidney function.
  • Urinalysis checks your urine for wastes and other abnormal substances.
  • Urine protein test checks for protein in your urine.

Your healthcare provider may also do a kidney biopsy. This is a procedure to examine a small piece of tissue or sample of cells from your kidneys. A biopsy can help your healthcare provider determine the severity of your kidney damage.

Management and Treatment

How is lupus nephritis treated?

Medication and diet changes are the most common treatments for lupus nephritis. Your healthcare provider may recommend:

  • Blood pressure medication: Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) help control blood pressure and reduce protein loss.
  • Corticosteroids and immunosuppressive drugs: These medications prevent your immune system from attacking the blood vessels in your kidneys.
  • Diet changes: You may need to reduce your sodium (salt) intake. Eating less protein, such as meat and dairy, can also make it easier for your kidneys to work. Work with your healthcare provider and a dietitian to build a healthy diet tailored to your needs.
  • Diuretics: These medications help treat edema (excess fluid and swelling). Diuretics can also lower your blood pressure.

Will I need surgery or dialysis for lupus nephritis?

Kidney failure develops in 10% to 30% of people with lupus nephritis. If this happens, you may need:

  • Dialysis, which is a procedure to clean your blood when the kidneys aren’t working correctly.
  • Kidney transplant, which is a surgical procedure that replaces one of your failing kidneys with a healthy kidney from a donor.

Prevention

How can I prevent lupus nephritis?

If you have lupus, there’s no clear way to prevent lupus nephritis. Some medications (i.e., hydroxychloroquine) might prevent it, so it’s important to follow-up with your hematologist and be treated for lupus if needed.

Outlook / Prognosis

What’s the prognosis (outlook) for people with lupus nephritis?

People who receive timely treatment for lupus nephritis have a positive outlook. People with lupus nephritis who receive medication, dialysis or a kidney transplant tend to do as well as people with other kidney diseases who receive these treatments. But most people need to manage the disease with medication or dialysis for the rest of their lives.

What are the long-term complications of lupus nephritis?

In addition to kidney failure, other long-term complications of lupus nephritis include:

  • Higher risk of certain cancers, including B-cell lymphoma.
  • Heart and blood vessel problems.

Living With

When should I call my doctor about lupus nephritis?

Contact your healthcare provider right away if you experience any of the following symptoms, as they could be signs of sudden kidney failure:

A note from Cleveland Clinic

Lupus nephritis is kidney inflammation and damage due to lupus, an autoimmune disease. The condition prevents your kidneys from working as they should. It’s important to seek treatment for lupus nephritis right away. Managing the condition with medication and diet changes may help delay or prevent kidney failure. People with severe lupus nephritis may need dialysis or a kidney transplant.

Last reviewed by a Cleveland Clinic medical professional on 09/09/2021.

References

  • Boodhoo KD, Liu S, Zuo X. Impact of sex disparities on the clinical manifestations in patients with systemic lupus erythematosus. (https://journals.lww.com/md-journal/fulltext/2016/07190/impact_of_sex_disparities_on_the_clinical.31.aspx) Medicine. 2016 July;95(29):e4272. Accessed 9/22/2021.
  • Lupus Foundation of America. What is lupus nephritis? (https://www.lupus.org/resources/what-is-lupus-nephritis) Accessed 9/22/2021.
  • Lupus Foundation of America. What is lupus? (https://www.lupus.org/resources/what-is-lupus) Accessed 9/22/2021.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Lupus and Kidney Disease (Lupus Nephritis). (https://www.niddk.nih.gov/health-information/kidney-disease/lupus-nephritis) Accessed 9/22/2021.
  • National Kidney Foundation. Lupus and Kidney Disease (Lupus Nephritis). (https://www.kidney.org/atoz/content/lupus) Accessed 9/22/2021.

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