Lupus nephritis is a serious complication of the autoimmune disease systemic lupus erythematosus (SLE), the most common type of lupus. SLE occurs when the immune system’s autoantibodies mistakenly attack healthy cells, causing inflammation in and sometimes permanent damage to various organs including the heart, kidneys, brain, joints, and skin. 

In lupus nephritis, the autoantibodies attack the healthy delicate filtering system inside the kidneys that remove toxins and wastes from the blood. This condition can worsen over time and result in kidney failure. Learn about the symptoms of lupus nephritis, how it’s diagnosed and treated, and who is most at risk.* 

Who is most at risk for developing lupus nephritis?

Lupus often causes kidney damage, and five out of 10 adults with lupus will develop kidney disease. While lupus is much more common in women, lupus nephritis occurs more often in men. Black, Hispanic/Latino, and Asian Americans are particularly at risk for developing the condition. In children with lupus, approximately 8 out of 10 will experience kidney damage. 

What are some signs and symptoms?

Symptoms of kidney dysfunction typically appear soon after lupus symptoms do. Signs of lupus nephritis can include:

• Foamy urine 
• Edema (swelling) in the legs, feet, ankles, hands, and/or face from fluid retention
• High blood pressure
• Pain and/or swelling in the joints
• Muscle pain
• A red rash, often on the nose and cheeks, with a butterfly-like shape
• Inexplicable fever 

How is lupus nephritis diagnosed?

Lupus nephritis is diagnosed through urine and blood tests and a kidney biopsy.

• Urine test. Also called a ‘dipstick’ test, for the strip of chemically-treated paper that is dipped into your urine to test for red blood cells and protein. High levels of either indicate kidney damage. Your urine will also be checked for kidney cells.
• Blood test. Measures creatinine, a normal byproduct of muscle metabolism. Since the kidneys remove creatinine from your blood, the presence of more than a tiny amount of creatinine in your blood signals kidney dysfunction.
• Kidney biopsy. Examination of a small piece of kidney tissue can confirm a lupus nephritis diagnosis and help determine the disease’s progression. The procedure is performed in a hospital by a surgeon. Patients are usually given a local anesthetic and light sedation.

How is lupus nephritis treated?

The goals of lupus nephritis treatment are to:

• Reduce inflammation,
• Prevent the antibodies from attacking your kidneys, and
• Prevent your immune system from generating those antibodies.

Doctors currently treat lupus nephritis with medications such as:

• Corticosteroids (typically prednisone) to relieve inflammation, and 
• Immunosuppressants (usually cyclophosphamide or hydroxychloroquine). 

Your healthcare provider may also prescribe drugs to lower your blood pressure, the most common being:

• ACE inhibitors and angiotensin II receptor blockers (ARBs)
• Diuretics (to help flush excess fluids)
• Beta blockers and calcium channel blockers

Take all medicines as prescribed by your physician. 

What complications can lupus nephritis cause?

Approximately 10% to 30% of people with lupus nephritis experience kidney failure. A severe form of the condition–diffuse proliferative nephritis–can permanently scar the kidneys, with more scars leading to greater decline in kidney function.

Lupus nephritis can also increase the hrisk of vascular diseases and certain cancers, particularly B-cell lymphoma.

Early identification and treatment of lupus nephritis can help protect your kidneys from progressive damage and dysfunction, and prevent further health complications.

*National Institute of Diabetes and Digestive and Kidney Diseases. (N.D.). Lupus and Kidney Disease (Lupus Nephritis). https://www.niddk.nih.gov/health-information/kidney-disease/lupus-nephritis#:~