The Relationship between Lupus and Kidney Disease

Around 1.5 million people in the US have lupus and 60 percent of them have a type that attacks their kidneys.¹ This can lead to chronic kidney disease (CKD) and even end stage renal disease (ESRD). Understanding the relationship between lupus and kidney disease can help you identify any potential risks early and seek treatment from your doctor.

Lupus is an autoimmune disease—meaning it causes your immune system to attack healthy cells. Doctors have found that people with family members who have an autoimmune disease are more likely to get lupus.² In addition to CKD and ESRD, lupus can also lead to heart failure.³

Systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE) are 2 types of lupus. SLE is the most common form and can damage your kidneys, possibly to the point of kidney failure. SLE and DLE share similar symptoms, but DLE doesn’t affect your kidneys.⁴

SLE can leave sores on your skin and cause both acute and chronic inflammation in multiple organs—including your kidneys. When lupus affects your kidneys, it’s called lupus nephritis and can lead to CKD. In addition to inflammation, lupus nephritis can scar the blood vessels in the glomeruli, which are the kidneys’ filters. This damage can cause kidney failure and eventually require dialysis or a kidney transplant.⁵

DLE only affects the skin and does not cause kidney damage. People with DLE often get round sores, also known as lesions, on their nose, cheeks, ears, or scalp. Both SLE and DLE can cause similar lesions, so it’s possible to mistake SLE for DLE.⁴

Diagnosing lupus can take a long time because it has many of the same symptoms as other diseases. Identifying the correct diagnosis may require your doctor to look at your medical history, family history, and lab tests.² You can help determine the type of lupus you may have by letting your doctor know if you have foamy or bloody urine, swelling in your lower limbs, lesions, a butterfly-shaped rash on your nose and cheeks, intense or prolonged fatigue, chest pain, hair loss, light sensitivity, or nose or mouth ulcers.

Symptoms that may indicate SLE and possible kidney damage include foamy urine and swelling. Your doctor may perform the following tests on your kidneys:

• Urine test to see whether protein or blood is present in your urine
• Blood test to see how much creatinine—a waste product your body makes and your kidneys filter—is in your bloodstream
• Kidney biopsy to examine a small sample of your kidney under a microscope and determine if lupus is causing any inflammation or scarring⁵

Dermatologists—skin care doctors—can use a skin biopsy to determine whether you have DLE. Your dermatologist will collect a small skin sample for another expert to examine under a microscope to see if you have DLE.⁴

You can manage SLE and CKD by eating less salt, removing saturated fats from your diet, and taking the medications your doctor may prescribe you⁶:

• Immunosuppressant drugs and corticosteroids weaken your inflammatory response so they don’t do as much harm to your kidneys.
• Blood pressure medications can protect your kidneys while lowering blood pressure and the amount of protein in your urine. High blood pressure may be a side effect of your treatment.⁷
• Diuretics—also known as water pills—help the kidneys release extra fluid and sodium in your body. This can reduce any swelling. You may have to use the bathroom more frequently because your body removes excess fluid through the urine.⁷

Minimize DLE flare-ups by avoiding the sun and taking any medications your doctor may prescribe you, such as⁴:

• Steroid ointments to lower inflammation and decrease swelling
• Anti-inflammatory medicines to reduce pain and swelling
• Antimalarial medicines to reduce rashes and joint pain
• Calcineurin inhibitors to decrease inflammation

You can help treat lupus and kidney disease by telling your doctor the symptoms you are experiencing and by learning about the different types of lupus. This can help you receive the proper diagnosis, limit how lupus affects your everyday life, and preserve your kidneys.