Refresher Course: Lupus Nephritis (Kidney Disease)

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Lupus nephritis is an inflammation of the kidney caused by systemic

lupus erythematosus (SLE), a disease of the immune system. SLE causes

harm to the skin, joints, kidneys, and brain. Lupus Nephritis is

characterized by damage to the glomeruli and progressive loss of kidney

function.

Lupus often causes nephrotic syndrome (excessive protein excretion) and

may progress rapidly to renal failure. There is progressive azotemia

(the accumulation of nitrogenous waste products in the blood stream) and

urinary abnormalities including protein and blood in the urine.

Some people with SLE may have no symptoms of kidney disease. However,

lupus nephritis may cause weight gain, high blood pressure, dark urine,

or swelling around the eyes, legs, ankles, or fingers.

Prevention:

There is no known prevention for lupus nephritis.

Symptoms:

• blood in the urine

• foamy appearance to urine

• swelling of any area of the body

• elevated blood pressure

Signs that begin a diagnosis of Lupus nephritis:

Examination of patient indicates decreased kidney functioning with edema

(swelling of body tissue) and may indicate renal failure.

Tests:

• Abnormal urinalysis with protein, casts, and red blood cells present

in the urine.

• ANA titer is high.

• Syphilis tests may be falsely positive.

• BUN and creatinine may be used to assess kidney functioning.

• A lupus erythematosus (LE) cell test is positive.

• A Kidney biopsy is indicated, not to diagnose lupus nephritis, but to

determine what treatment is appropriate for the renal component of SLE.

• A urine immunoglobulin light chain is elevated.

Treatment:

Treatment depends on the symptoms. Medicines can decrease swelling,

lower blood pressure, and decrease inflammation by suppressing the

immune system. Patients may need to limit protein, sodium, and potassium

intake in their diet.

Corticosteroids or other immunosuppressive medications are often

effective in reducing symptoms.

Dialysis may be necessary to control symptoms of acute or chronic renal

failure. Renal failure may be severe enough to require dialysis even if

no other symptoms of SLE are present.

A kidney transplant may be recommended to treat kidney failure resulting

from lupus nephritis.

Complications:

• acute renal failure

• chronic renal failure

• end-stage renal disease

• nephrotic syndrome

Prognosis:

The outcome varies. It is usually worse with diffuse proliferative lupus

nephritis (one specific form of the disorder). The course of treatment

is varied following acute episodes and remissions (symptom-free

periods).

Some cases of lupus nephritis may progress to chronic renal failure.

Over 80% of people with lupus nephritis severe enough to require

dialysis or transplantation will survive for more than 5 years after

treatment. Although lupus nephritis may recur in a transplanted kidney,

it rarely leads to end stage renal disease. People with active lupus

should not undergo transplantation.

Information gathered from:

National Institute of Arthritis and Musculoskeletal and Skin Diseases

(NIAMS)

National Institutes of Health

Yahoo Health and A.D.A.M., Inc.