Lupus and Kidney Disease (Lupus Nephritis)

There are two types of lupus. Systemic lupus erythematosus (SLE) is the form of lupus that can harm your skin, joints, kidneys and brain and may be fatal. The other form of lupus is called "discoid" lupus erythematosus, which affects only your skin. When systemic lupus erythematosus (SLE) affects the kidneys it is called lupus nephritis. Lupus is an "autoimmune" disease, meaning your immune system (your body’s defense system), which usually protects the body from disease, turns against the body. This causes harm to organs and tissues, like your kidneys. Lupus nephritis results in inflammation (swelling or scarring) of the small blood vessels that filter wastes in your kidney (glomeruli).

No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants (car fumes, factory smoke) may play a role in causing the disease. Men and women of all ages and races get lupus. However, about 90 percent of people diagnosed with lupus are women.

Lupus nephritis can cause many signs and symptoms and may be different for everyone. Signs of lupus nephritis include:

• Blood in the urine (hematuria): Glomerular disease can cause your glomeruli to leak blood into your urine. Your urine may look pink or light brown from blood, but most often you will not be able to see the blood cells except with a microscope.
• Protein in the urine (proteinuria): Glomerular disease can cause your glomeruli to leak protein into your urine. Your urine may be foamy because of the protein.
• Edema: Having extra fluid that your kidneys cannot remove that causes swelling in body parts like your legs, ankles, or around your eyes.
• Weight gain: due to the fluid your body is not able to get rid of.
• High blood pressure

Your doctor will do a physical examination, get your medical history, and do special tests. These tests include:

• Urine test to check for protein and blood
• Blood tests
  • Check your levels of protein and cholesterol
  • Check your eGFR (estimated glomerular filtration rate) to show how well your kidneys are filtering wastes
  • Check for antiphospholipid antibodies  and anti-nuclear antibodies (ANA) at least once during your disease.
• Kidney biopsy to look at a tiny piece of the kidney under a microscope

Lupus is treated with drugs that block your body's immune system. These include drugs like steroids (corticosteroid) and antimalarial drugs. Everyone is different and your doctor will make a treatment plan that is right for you. This may include a combination of therapies. Usually treatment for lupus nephritis includes:

• Corticosteroids (often called “steroids”)
• Immunosuppressive drugs
• Monoclonal antibodies
• ACE inhibitors and ARBs
• Diuretics
• Diet change

Corticosteroids and immunosuppressive drugs: These medicines are used to calm your immune system (your body’s defense system) and stop it from attacking your glomeruli.

ACE inhibitors and ARBs: These are blood pressure medicines used to reduce protein loss in the urine and control blood pressure.

Monoclonal antibodies: These are man-made proteins that act like antibodies and target only one type of substance in the body.

Diuretics: These medicines help your body get rid of excess fluid and swelling. These can be used to lower your blood pressure too.

Diet changes: Some diet changes may be needed, such as reducing salt (sodium) and protein in your food choices to help control blood pressure and lighten the load of wastes on the kidneys.

You should always speak with your doctor about the risks and benefits of any of the treatments you receive. Each of the drugs during any of these treatments can have their own side effects. Fortunately, these side effects usually are manageable for most patients. Discuss your treatment with your healthcare provider.  Your overall health and the health of your kidneys should always be considered. There are times when the side effects of certain treatments are not worth the risk to your health.

If you are a woman with lupus nephritis and want to have children, you should discuss with your healthcare provider the effect your treatment may have on that process. There are ways to make sure that treatment is less harmful to this process.

Most patients do well long-term. You may need to take drugs over many years. Even patients who have less flare-ups or symptoms should have periodic checkups.

If your kidneys fail, you can be treated with dialysis or a kidney transplant. Lupus patients do as well with these treatments as people who have other types of kidney disease.

Many patients with lupus nephritis have received a kidney transplant. The drugs used to prevent your body from rejecting the new kidney are the same or similar to those used to treat lupus. It is unusual for lupus to come back in the new kidney. Lupus patients with new kidneys do as well as any other patients with transplanted kidneys.

For more information on Lupus visit the Lupus Foundation at www.lupus.org