Lupus nephritis (inflammation of the kidney) is an autoimmune, chronic kidney disease in which the immune system attacks the body’s cells and tissues. It is a serious complication of systemic lupus erythematosus (SLE), an autoimmune disease affecting the skin, joints, kidneys, and brain.
- Lupus nephritis affects millions of people worldwide and is more common in women than in men and people of African and Asian ethnicities.
- Lupus nephritis may lead to kidney inflammation, and swelling of the blood vessels, resulting in hematuria (blood in the urine), proteinuria (protein in the urine), elevated blood pressure, impaired kidney function, and eventually, kidney failure.
- Exams and tests include urine tests, blood tests, and a kidney biopsy.
- Early diagnosis and prompt treatment may help protect the kidneys.
- The life expectancy of lupus nephritis depends on the severity of the symptoms and immune response to medications. With proper treatment, maintaining a healthy lifestyle and regular follow-ups, 80 to 90 percent of people with lupus nephritis are expected to live for the average lifespan.
- Lupus may be life-threatening for people with a severe flare-up of the disease. Some may require renal transplantation to lead a relatively normal life.
What causes lupus nephritis?
The cause of lupus nephritis is unknown, but it is speculated that multiple factors, such as infections, viruses, abnormal immune response to an indolent infection, toxic chemicals, or pollutants, may play a key role in developing the disease.
What are the stages of lupus nephritis? 6 Stages
A system developed by the World Health Organization (WHO) in 1964 to classify lupus nephritis is revised by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS) in 2003.
The 6 stages of lupus nephritis include:
- Class I: Minimal mesangial lupus nephritis.
- Class II: Mesangial proliferative lupus nephritis.
- Class III: Focal lupus nephritis (active and chronic, proliferative, and sclerosing).
- Class IV: Diffuse lupus nephritis (active and chronic, proliferative and sclerosing, segmental, and global).
- Class V: Membranous lupus nephritis.
- Class VI: Advanced sclerosis lupus nephritis.
What are the signs and symptoms of lupus nephritis?
The most common signs and symptoms of lupus nephritis include:
- Foamy or frothy urine
- Swelling of the legs, feet, and ankles
- Swelling of face or hands
- Increased frequency or urgency to urinate, especially at night
- High blood pressure
- Arthritis (pain in the joints)
- Weight gain
- Muscle pain
- Pyrexia (fever of unknown origin)
- Red rash on the face across the nose and cheeks called a butterfly rash
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How is lupus nephritis diagnosed?
The doctor will analyze your medical history, perform a physical examination, and recommend certain tests, such as:
- Urine test: A sample is collected to look for the presence of blood and protein in the urine.
- Blood test:
- Serum creatinine, a waste product that accumulates from the normal wear and tear of muscles is measured, which is directly proportional to the extent of kidney damage.
- To check the levels of protein and cholesterol.
- To check for antiphospholipid antibodies and antinuclear antibodies.
- Kidney biopsy: A procedure involving ultrasound or computed tomography scan guidance to scrape a small piece of kidney tissue to be examined under a microscope to analyze signs of damage.
Can lupus nephritis be cured?
Early diagnosis and prompt treatment may help protect the kidneys.
Lupus nephritis is treated with medicines to suppress the immune system and prevent further kidney damage, which aims to:
- Reduce inflammation in the kidneys
- Decrease or suppress the immune system
- Block the immune cells to produce antibodies that lead to kidney damage
Treatment of lupus nephritis may include:
- Corticosteroids, such as prednisone, to reduce swelling
- Medications to suppress the immune system (immunosuppressive drugs), such as cyclophosphamide and mycophenolate mofetil
- Diet changes, such as reducing salt and protein intake to control blood pressure, sufficient fluid intake to maintain hydration, regular exercise, avoiding alcohol and smoking
- Medications to control blood pressure
- angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
- Calcium channel blockers
- Dialysis: It involves filtering the blood through a machine in rare cases of kidney failure.
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National Institutes of Health. Lupus and Kidney Disease. https://www.niddk.nih.gov/health-information/kidney-disease/lupus-nephritis
National Kidney Foundation. Lupus and kidney disease. https://www.kidney.org/atoz/content/lupus
Brent LH. Lupus nephritis. Medscape. https://emedicine.medscape.com/article/330369-overview
Dunkin MA. Lupus Nephritis. WebMD. https://www.webmd.com/lupus/lupus-nephritis
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