Lupus Nephritis Symptoms and Treatment

If you've been diagnosed with lupus, you'll want to learn the signs and symptoms of a form of the disease called lupus nephritis (LN) that affects the kidneys. Lupus nephritis occurs in up to 60% of people with lupus. Among people who have lupus nephritis, 10 to 30% develop kidney failure, so it's important that you are aware of the signs and symptoms.

Overview

Lupus nephritis is kidney inflammation caused by lupus. For the most part, kidney problems in lupus are caused by damage to clusters of blood vessels in the kidneys called glomeruli. People who have lupus and associated glomerular damage have lupus glomerulonephritis (LGN). LGN occurs when antibodies and complement proteins build up in the kidneys and cause inflammation.

Signs and Symptoms

If you are developing lupus nephritis, you may notice these signs and symptoms:

• Foamy urine
• Blood in urine
• Increased urinary frequency
• Swelling, usually in the feet, ankles, and legs
• High blood pressure
• Joint pain or swelling
• Muscle pain
• Fever with no known cause
• Red rashes, often on the face

Diagnosis

To determine if you have lupus nephritis, your physician will conduct urine tests, as well as a physical exam to check your blood pressure and look for fluid build-up around the body, called edema. A blood test may be used to look for high levels of creatinine, a waste product that increases when the kidneys are not functioning well.

Once it's strongly suspected that you have lupus nephritis, your healthcare provider will order a kidney biopsy. There are six types of lupus glomerulonephritis that vary in severity. A biopsy will help identify what type of LGN you have. This diagnosis will help predict the expected course of your kidney problems and guide your treatment.

Because some types of LN can result in complete kidney dysfunction and dependence on dialysis, biopsy results are necessary to shape your care plan and help determine which therapy is necessary and how aggressive it needs to be.

Treatment

If you're diagnosed with lupus nephritis, your treatment will focus on improving your kidney function. There are a few options available, and most likely your treatment will be individualized based on the severity and other factors of your disease. Some treatments include:

• Medications: Treatment may start with medications to suppress the immune system and reduce inflammation in the kidneys. Corticosteroids or immunosuppressives are used for this. Diuretics can be used to eliminate excess fluid and reduce swelling.
• Maintaining a healthy blood pressure: Blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), may be prescribed.
• Changes to your diet: You may be instructed to reduce salt (sodium) from your diet.
• Some patients may be put on anticoagulation: This may be the case because of an associated increased risk of thrombotic events. Statins may be used for an associated increase in lipids.

The good news is that, for most people, treatment for lupus nephritis is highly effective.