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Lupus nephritis is kidney inflammation and damage caused by systemic lupus erythematosus (SLE), also known as lupus. Lupus is an autoimmune disorder in which the immune system attacks healthy tissues in the body. Lupus triggers your immune system to generate autoantibodies, which target and harm your body’s own tissues and organs. Aside from affecting your kidneys, lupus can also inflict damage on your brain, heart, joints, skin, and various other body parts.
Lupus nephritis prevents the kidneys from keeping blood pressure and volume under control, filter wastes from the body, regulate hormone levels, and maintain proper amounts of bodily fluids, such as salts, acids, and minerals.
Kidney inflammation can lead to blood in the urine, protein in the urine, high blood pressure, and reduced kidney function. In severe cases of lupus nephritis, kidney failure and end-stage renal disease, among other major health issues may arise. Treatment options usually include medication, dialysis or a kidney transplant.
Symptoms
Lupus nephritis symptoms usually begin about five years after lupus symptoms initially appear. It can be the primary, and sometimes the sole symptom of lupus.
Lupus nephritis signs and symptoms include:
- Swelling in the lower body or around the eyes, due to fluid retention
- Hematuria, or the presence of blood in the urine
- Proteinuria or foamy urine, which indicates too much protein in the urine
- Urination has increased, particularly at night
- High blood pressure
- High levels of creatinine, a waste product, in the blood
- Fever with unknown cause
- Swelling or pain in the joints
- Muscle pain
- Face rash with red skin
Causes
Lupus nephritis is a condition in which the body assaults the kidneys, causing inflammation and impaired kidney function. Immune system proteins in systemic lupus damage the kidneys, impairing their ability to filter waste. This chronic inflammation causes scarring and irreversible kidney damage. Lupus nephritis affects up to 50% of persons with systemic lupus.
Risk factors
Lupus nephritis affects only adults and children with lupus disease. Certain risk factors may contribute to the chance of developing lupus, such as:
- Sex: Men are more likely to develop lupus nephritis than women.
- Race or ethnicity: African American, Native American, Hispanic/Latino, Pacific Islander, or Asian ancestry have higher susceptibility to this disease.
- Environment: People who come into touch with specific illnesses, viruses, hazardous chemicals, or pollutants have a higher risk for lupus nephritis.
- Family history: If a family member has lupus nephritis, the risk of getting it also increases.
- Having another autoimmune disease
Diagnosis
Several tests may be required to confirm the diagnosis, such as:
- Physical examination: Healthcare provider will discuss the signs and symptoms, and evaluate one’s medical history are all necessary in the diagnosis of lupus nephritis.
- Blood and urine tests: These tests assess how effectively the kidneys are functioning. Antibody blood tests look for elevated quantities of proteins produced by the immune system. A urinalysis looks for wastes and other unusual substances in the urine, including protein. One may be asked to collect the urine for an entire day in addition to regular blood and urine testing.
- Kidney biopsy: A biopsy can help the doctor identify the severity of the kidney impairment. A small part of kidney tissue is extracted for laboratory examination. This procedure is considered as the most conclusive diagnostic for lupus nephritis.
Treatment
The treatment for lupus nephritis usually aims to manage the condition, since no definite cure is available. Specifically, the goal of the treatment is to reduce or eliminate symptoms, prevent the condition from worsening, retain remission, and avoid the need of dialysis or a kidney transplant. Several treatment options are available ranging from conservative to aggressive procedures.
- Conservative treatments: The healthcare provider may start with medications and lifestyle changes as part of the initial treatment:
- Diet changes: With the help of a nutritionist, building a healthy diet suited for one’s unique needs may be beneficial. Eating less protein, such as meat and dairy, and lowering salt intake can also help the kidneys perform more efficiently.
- Blood pressure medications: Diuretics are medications that can help get rid of excess fluid. Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) are blood pressure medications that assist regulate blood pressure and minimize protein loss.
- Medication: Corticosteroids and immunosuppressive drugs can block the immune system from attacking the kidney blood vessels. Prednisone and other steroids, cyclosporine, tacrolimus, cyclophosphamide, azathioprine, mycophenolate, rituximab, and belimumab may be prescribed for severe cases of lupus nephritis.
The healthcare provider may discuss the benefits and side effects of each drug and determine which medication is the most beneficial. Several clinical trials are ongoing for new drugs for this condition.
- Treatment options for kidney failure: Kidney failure occurs in 10% to 30% of lupus nephritis patients. Advanced stage of lupus nephritis may require a more extensive treatment, such as:
- Dialysis: This is a process that cleans the blood when the kidneys are not performing properly. By filtering the blood through a machine, dialysis helps maintain the proper balance of minerals in the blood, regulate blood pressure, and eliminate fluid and waste from the body. Two types of dialysis include hemodialysis and peritoneal dialysis.
- Kidney transplant: A kidney transplant is a medical operation in which one of the failing kidneys is replaced with a healthy kidney from a donor.
