Understanding Lupus Nephritis

Lupus itself can be hard to detect and diagnose, because most lupus symptoms could easily be attributed to other diseases. On average, it can take up to 6 years after initial symptoms before a person is diagnosed with lupus. Common symptoms of lupus may include:

• Pain, swelling and stiffness in your muscles and joints
• Unexplained fever of 100°F.
• Intense or prolonged fatigue
• Inflammation
• Chest pain
• Hair loss
• Raised red patches or rashes on your skin
• Butterfly-shaped rash on your nose and cheeks
• Sensitivity to light
• Ulcers in your nose or mouth

When lupus affects kidneys, symptoms can also be difficult to recognize. If you do notice any of the following symptoms of lupus nephritis, it’s important to alert your doctor:

• Foamy urine
• Blood in your urine
• Swelling in your legs, ankles, or elsewhere due to fluid retention

There are several tests that doctors use when determining whether lupus is affecting your kidneys. This process can take time, especially if you don’t already have a lupus diagnosis.

Blood and urine tests are commonly used to check kidney function, though they can’t always explain what’s causing diminished kidney function. That means that if lupus is causing your kidney damage, it may take extra testing to verify. There are 3 tests commonly given:

1. A urine test will measure the amount of protein and blood in your urine. You’ll provide a urine sample, and your treatment team will use a dipstick to test the urine. The dipstick will change colors if it detects protein or blood. Elevated levels of either one is a sign that your kidneys aren’t working properly. 
2. A blood test will help measure how well your kidneys are working. A simple serum creatinine blood test measures the amount of creatinine in your bloodstream. Creatinine is made when the body breaks down protein, and it usually gets removed by healthy kidneys. When kidneys aren’t working properly, creatinine builds up in the blood. Your doctor with calculate your estimated glomerular filtration rate (eGFR) using your serum creatinine level, along with weight, gender and ethnicity, to measure your kidney function. You may also get a separate blood test to check for certain antibodies that indicate the presence of lupus. 
3. A kidney biopsy will help your care team understand whether lupus is causing the decreased kidney function. Using a CT scar or ultrasound to guide them, a doctor will take a small sample of your kidney so a pathologist in a lab can examine the piece to learn more. Studying the biopsy can help confirm the presence of lupus nephritis, the stage and how best to progress with treatment. 

There is currently no known cure for lupus. However, lupus and associated conditions like lupus nephritis can be managed with proper treatment. Lupus nephritis treatment will likely involve a rheumatologist (joint specialist) and nephrologist (kidney specialist) in addition to your other doctors. The goals of treating lupus are to:

• Reduce inflammation
• Manage the immue system response
• Prevent flare-ups
• Minimize pain and fatigue
• Minimize damage to organs

People with lupus and lupus nephritis may take medications to manage their symptoms. Prescribed medications may include:

• Immunosuppressant drugs and corticosteroids—to decrease your immune system’s response and help control inflammation. This is an important part of easing the effects of lupus.
• Blood pressure medications—to help manage high blood pressure that may arise as a side effect. 
• Diuretics—to help relieve the fluid buildup from diminished kidney function.

Because lupus can target any part of your body and every case is different, this isn’t a full list of medications you may be asked to take. Your doctor may also recommend dietary changes to help decrease stress on your kidneys, including cutting back on salt and managing phosphorus.