If you’re living with moderate to advanced chronic kidney disease (CKD), it’s natural to worry about what comes next—including the possibility of a kidney transplant. For those whose CKD is caused by lupus (an autoimmune disease that can damage the kidneys), new research brings both caution and clarity. A study from the Mayo Clinic looked at how often lupus nephritis—kidney inflammation caused by lupus—comes back after a transplant and how it shows up. Understanding these findings can help you and your care team make more informed decisions.*

Lupus Nephritis Often Returns Quietly After a Transplant

In a group of 112 patients who had kidney transplants due to lupus nephritis, about 36% experienced a return of the disease in their new kidney. Surprisingly, many of these cases had no obvious symptoms at first. Doctors found that 40% of the recurrences were only detected through routine biopsies—not through typical warning signs like protein in the urine or blood in the urine. This means that lupus nephritis can come back “silently,” without the patient knowing.

The average time for silent (or “histologic”) recurrence was about 12 months after the transplant, compared to 24 months for those who did show symptoms. Some cases were detected as early as 18 days after surgery. These findings highlight the importance of routine testing and biopsy—even if you’re feeling well.

Why Regular Monitoring Matters for Protecting Your Transplant

While lupus nephritis recurrence does not always lead to transplant failure, it can in more serious cases. In patients who had both lab abnormalities and changes seen in biopsies, half experienced kidney graft failure. That’s a high number, but it also means there’s a lot doctors can do to catch problems early and possibly prevent failure.

The researchers recommend an in-depth evaluation before and after transplant. This includes:

• Before transplant. Reviewing your original kidney biopsy and running tests for lupus activity, protein in urine, and specific antibodies.
  
• After transplant. Regular biopsies and lab tests, especially if protein or blood is found in the urine.
  

This kind of close follow-up can catch silent problems before they cause lasting damage. In some cases, early detection may allow for timely treatment adjustments.

Who Is Most at Risk—and What You Can Do

The study found that African American patients had the highest rate of lupus nephritis recurrence after transplant—about 48%. While the reasons are not fully understood, this finding underscores the need for tailored follow-up plans based on individual risk.

Even though some types of lupus nephritis showed up more often than others, there wasn’t a clear pattern matching original kidney disease with the kind that came back. That means no one is entirely “safe” from recurrence, even if their lupus seemed quiet before.

The bottom line? If you’re living with CKD from lupus and thinking about a kidney transplant—or already have one—stay proactive. Ask your care team about routine testing and personalized monitoring. Being informed and involved in your care is one of the most powerful tools you have.

*Persaud, N. (2025, May 27). Recurrent Lupus Nephritis After Kidney Transplantation Characterized. 

Rheumatology Advisor. https://www.rheumatologyadvisor.com/news/lupus-nephritis-after-kidney-transplantation-characterization-treatment-risk/ 

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