What is Lupus Nephritis?

Lupus nephritis is an autoimmune disorder that triggers your immune system to produce proteins called auto-antibodies that attack the tissues and organs, specifically the kidneys. Autoimmune diseases cause your immune system to attack your healthy cells. Lupus nephritis is a common complication in people with systemic lupus erythematosus (SLE) — more commonly known as lupus.

Lupus nephritis occurs when lupus auto-antibodies start affecting the kidneys, causing inflammation and possibly organ damage. Inflammation of the kidneys can harm the ability of the overall renal (kidney) system to properly remove waste from blood, maintain the correct amount of body fluids, and regulate hormone levels for controlling blood pressure and blood volume.

Kidney disease caused by lupus may worsen over time and lead to kidney failure.

Lupus Nephritis Symptoms

• Blood in urine

• High blood pressure or hypertension

• Edema (swelling due to fluid buildup) in your lower body or around your eyes.

• Foamy urine because of excess protein in the urine

• High levels of serum creatinine

• Muscle pain

• Unexplained fever

• Joint pain or swelling

• Weight gain

• Fatigue

• Frequent urination, especially at night

• A red rash on the face, across the nose and cheeks, also called a butterfly rash because of its shape

Lupus Nephritis Causes

The cause of lupus nephritis is systemic lupus erythematosus (SLE). However the cause of SLE is unknown. But researchers think they may be:

Genes: Very little evidence exists that particular genes directly cause lupus, but several genes may raise the risk for the disease. For example, people of specific ethnic descent, such as Hispanic, Asian, Pacific Island, Native American, and African, are more likely to get lupus, possibly due to shared genes.

Hormones: Lupus nephritis shows a female predilection. Its symptoms tend to increase before the menses and during pregnancy when estrogen is high. However, medications with oestrogen, like birth control pills and hormone replacement therapy, don't increase the risk of lupus. Scientists are still figuring out the existence of any connection between hormones and lupus and why it occurs predominantly in women.

Environment: Some environmental factors that may affect causing lupus nephritis are:

• Cigarette smoke

• Mercury exposure

• Viruses such as Epstein-Barr, herpes zoster (causes shingles), and cytomegalovirus

• Silica, a mineral from the Earth's crust found in sand, stone, concrete, and mortar

• UV light

• Stress

Lupus Nephritis Risk Factors

Only adults and children with SLE can develop lupus nephritis. Some known risk factors for lupus nephritis include:

• Women are more likely to develop lupus nephritis and most often strikes during the child-bearing years. Nine out of 10 people who have lupus are women.

• Race: Black, Native American, Hispanic/Latino, Pacific Islander, or Asian descent.

• Exposure to certain infections, viruses, toxic chemicals, or pollutants in the environment

• Have a family history of the disease.

• Have another autoimmune disease.

Lupus Nephritis Complications

Long-term complications of lupus nephritis are:

The most severe form of lupus nephritis, called diffuse proliferative nephritis, can cause scars to form in the kidneys. Scars are permanent, and kidney function often declines as more scars form. Early diagnosis and treatment may help prevent long-lasting damage.

People who have lupus nephritis are at a higher risk for cancer, primarily B-cell lymphoma NIH external link—a type of cancer that begins in the cells of the immune system. They are also at a high risk for Hypertension, heart and blood vessel problems.

Stages of Lupus Nephritis

Lupus nephritis can show up in various stages of severity. Determining the stages, therefore, is crucial as it helps guide treatment decisions and prognosis assessment.

There are six recognized stages of lupus nephritis, each indicating different levels of kidney involvement and potential complications. The higher the stage of the disease, the more severe it is.

Stage 1

• Minor kidney damage

• No obvious other signs or symptoms

Stage 2

• Some evident damage to the kidneys

• Presence of blood and protein in the urine

Stage 3

• More than 50% damage to blood vessels in the kidney

• Higher amounts of blood or protein in the urine

• Possible hypertension

Stage 4

• Damage to more than 50% of blood vessels in the kidney

• Blood or protein in the urine

• Possible hypertension

• Possible need for dialysis as kidneys malfunction or stop working entirely

Stage 5

• Thickening of essential parts of the kidney

• Mostly protein in the urine

• Possible hypertension

• Failure of the kidney is possible

Stage 6

• Damage to more than 90% of renal blood vessels, which is chronic & irreversible

• Protein in the urine

• Possible hypertension

• Mostly requires dialysis or renal transplant

Lupus Nephritis Diagnosis

Diagnosis of lupus nephritis begins with the kidney specialist suggesting a thorough medical evaluation, including a review of the patient’s medical history, a physical examination, and an assessment of their symptoms. The kidney specialist might also suggest various tests to confirm the diagnosis and assess the severity of the disease, in order to develop a personalised Lupus Nephritis treatment plan. Here are the tests that the patient might undergo for further evaluation and diagnosis of their condition.

Blood and Urine Tests

• Antibody blood tests assess increased levels of proteins made by the immune system.

• Lab tests to evaluate renal function.

• Urinalysis to evaluate the urine for RBCs and other cells

• Urine protein test to determine the presence of protein in the urine.

Kidney Biopsy

A kidney biopsy involves taking a small piece of kidney tissue for examination under a microscope. The biopsy is done in the hospital using ultrasound or CT scan imaging techniques to guide the biopsy needle into the kidney. The area is first numbed to limit the pain, and light sedation may be used during the procedure. A kidney biopsy helps:

• Confirm a diagnosis of lupus nephritis

• Gives information about disease progression

• Guides in formulating a treatment plan

Lupus Nephritis Management and Treatment

Lupus nephritis is a chronic condition with no cure, but treatment can help manage the disease and improve long-term outcomes. The primary goals of lupus nephritis treatment are to:

• Reduce or eliminate symptoms, such as blood in the urine, foamy urine, and swelling in the hands, feet, and face.

• prevent disease progression, which can lead to further kidney damage and other complications.

• Maintain remission, which is a period of time during which the disease is under control and there are no symptoms.

• Avoid the need for dialysis or kidney transplant, which are more invasive and risky treatments.

Usually, doctors recommend the following conservative Lupus Nephritis treatment:

• Blood pressure medication: Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) help manage blood pressure and reduce protein loss.

• Corticosteroids and immunosuppressive drugs: These medications prevent your immune system from attacking the blood vessels in your kidneys.

• Diet changes: You may need to reduce your sodium (salt) intake. Eating less protein, such as meat and dairy, can also make it easier for your kidneys to work. Work with your healthcare provider and a dietitian to build a healthy diet tailored to your needs.

• Diuretics: These medications help treat edema (excess fluid and swelling). Diuretics can also lower your blood pressure.

In case of severe lupus nephritis, drug therapy that suppresses the immune system is typically recommended. The specific medications (steroids/MMF/Cyclophosphamide or others) are used to treat severe lupus nephritis will vary depending on the individual patient's needs and response to treatment.

Treatment for Kidney Failure

• Despite receiving treatment, the decline in kidney function can still advance When both kidneys become non-functional, individuals with lupus nephritis may require additional interventions for their kidney health.

• Kidney Dialysis Kidney dialysis is a procedure that assists in eliminating excess fluid and waste from the body. It sustains the proper balance of minerals in the bloodstream and regulates blood pressure by filtering the blood through a specialised machine.

• Kidney Transplant In a kidney transplant, a new kidney is surgically implanted from either a living or deceased donor. This procedure offers the opportunity to replace a non-functional kidney with a healthy one, restoring normal kidney function.

Diagnosed with Lupus Nephritis? Note from KKI

With early diagnosis and treatment, most people with lupus nephritis can live long and healthy lives. Recent advances in treatment have greatly improved the prognosis for this condition. For example, as per The National Center for Biotechnology Information’s report (updated July 2023), the 5-year survival rate is as high as 85% whereas the 10-year survival rate is 73%.

It is possible to live a normal life with lupus nephritis. With proper management, most people with this condition can enjoy a good quality of life. It is important to work closely with your doctor to develop a treatment plan that is right for you and to monitor your progress over time.

Living with LN means paying extra attention to your health. It’s important to know how to handle everyday issues, from what medicine to take to changes in your lifestyle.

People with LN need to make smart lifestyle choices. Remember, it’s never too late to make the changes to improve your overall health and wellbeing:

• Don’t smoke: Smoking can make your condition worse, so it’s best to avoid it.

• Keep active: Try to stay active with exercises that you enjoy and that are safe for you. Talk to your healthcare provider about how to exercise safely.

• Eat well: A nutritious and healthy diet is key. Eat plenty of fruits, vegetables, and whole grains. And cut back on highly processed foods, salty snacks, and sugary drinks.

• Be careful with over-the-counter (OTC) medicines and herbal/vitamin supplements: Talk to your doctor before you take any new medicines, especially OTC pain relievers like ibuprofen (Motrin or Advil) or naproxen (Aleve), also known as nonsteroidal anti-inflammatory drugs (NSAIDs) that can harm your kidneys.

• Medicines like acetaminophen (Tylenol) may be safer at recommended doses, depending on your other health conditions. Also, some herbal and vitamin supplements may not be good for you. Always check with your healthcare provider before using any new medications or supplements.

• Alcohol use: Drinking alcohol should be limited to moderate use only.

• Stay up-to-date on vaccines: Protect yourself from infections by getting vaccinations when they are due, especially if your LN treatment has weakened your immune system.

• Tests for bone health and anemia (low iron) recommended: Your doctor may suggest tests to check your bones and blood to catch any problems early.

• Watch your sun exposure: Since people with LN are at a higher risk for skin cancer, you should wear sunscreen whenever you’re outside.

• Consider using birth control: Pregnancy may be risky, so it’s important to talk to your healthcare provider when you are thinking about your reproductive plans.

• Look after your mental health: Don’t hesitate to get help if you’re feeling stressed, depressed, or anxious. Talking to someone about your feelings can really help.

Take your medications as prescribed.
See your doctor regularly for checkups.