Overview
Lupus nephritis is a frequent complication in people who have systemic lupus erythematosus, commonly known as lupus. It occurs when lupus autoantibodies attack structures in the kidneys that filter out waste, causing kidney inflammation, blood in the urine, foamy urine due to excess protein, high blood pressure, swelling in the hands, ankles, or feet, and high levels of a waste product called creatinine in the blood. Half of adults with systemic lupus may develop lupus nephritis, with risk factors including sex (men are more likely to develop it) and race or ethnicity (blacks, Hispanics/Latinos, and Asian Americans are more prone to lupus nephritis than whites).
Understanding the disease
Symptoms
The symptoms of lupus nephritis include:
- Blood in your urine
- Foamy urine (due to excess protein in urine)
- High blood pressure
- Swelling in your hands, ankles, or feet
- High levels of a waste product called creatinine in your blood. Additional symptoms of advanced lupus nephritis or kidney failure may include:
- Rashes and itchy skin
- Muscle cramps
- Upset stomach and vomiting
- Less appetite
- Metallic taste in the mouth
- Confusion It is important to seek medical attention if you experience any of these symptoms or if you notice sudden swelling in your hands or feet.
Risk Factors
Risk factors for developing lupus nephritis include sex and race or ethnicity. Women are more likely to have lupus, but men are more likely to develop lupus nephritis. Blacks, Hispanics/Latinos, and Asian Americans are more likely to have lupus nephritis than whites.
Development
Lupus nephritis develops when lupus autoantibodies, which are proteins produced by the immune system in people with systemic lupus erythematosus (lupus), attack structures in the kidneys responsible for filtering waste. This causes inflammation in the kidneys, which can result in symptoms such as blood in the urine, foamy urine due to excess protein, high blood pressure, swelling in the hands, ankles, or feet, and high levels of a waste product called creatinine in the blood.
Assessment and Diagnosis
Triage
You should see a doctor if you notice symptoms of lupus nephritis, such as blood in the urine, foamy urine due to excess protein, high blood pressure, swelling in the hands, ankles, or feet, and high levels of creatinine in the blood. It's important to get a checkup if you observe these symptoms, as they could indicate a serious health problem.
Diagnosis
The most definitive test for diagnosing lupus nephritis is a kidney biopsy, where a small section of kidney tissue is removed for lab analysis. Blood and urine tests, including a complete blood count and urinalysis, are also used to diagnose lupus nephritis. These tests measure kidney function and detect any abnormalities. In addition to lab tests, a physical examination and review of symptoms and medical history help doctors diagnose lupus nephritis.
Management and Treatment
Complications
Lupus nephritis can lead to worsened kidney function or kidney failure. If the kidneys can't filter blood well enough due to buildup of autoantibodies, levels of waste products can rise quickly in the blood. In severe cases, this can result in acute kidney failure.
Treatment
The treatments for lupus nephritis are aimed at controlling inflammation, reducing proteinuria (excess protein in the urine), and preventing kidney failure. Treatment options may include:
- Medications: Doctors may prescribe corticosteroids and immunosuppressive drugs to reduce inflammation and suppress the immune system. Other medications, such as ACE inhibitors and angiotensin receptor blockers (ARBs), can help control blood pressure and protect the kidneys.
- Blood pressure management: High blood pressure can further damage the kidneys in people with lupus nephritis. It is essential to keep blood pressure under control through lifestyle changes, such as a healthy diet and regular exercise, as well as medications if needed.
- Kidney protective measures: Patients may be advised to limit the intake of salt, proteins, and fluids to reduce the workload on their kidneys.
- Monitoring and follow-up: Regular monitoring of kidney function, blood pressure, and urine protein levels is essential to assess the effectiveness of treatment and detect any potential complications early on. It is important to note that the specific treatment plan for lupus nephritis will depend on the severity of the kidney involvement and the individual patient's circumstances. Consultation with a healthcare professional experienced in managing lupus and lupus nephritis is crucial for determining the most appropriate treatment approach.
Preparing for medical consultation
Preparing for an appointment for lupus nephritis involves taking certain steps to ensure you have all the necessary information and are well-prepared for the discussion with your healthcare provider. Here are some suggestions for preparing for an appointment for lupus nephritis:
- Make the appointment: Contact your healthcare provider to schedule an appointment with a specialist in rheumatology or nephrology, depending on their expertise in managing lupus and kidney-related issues.
- Gather your medical records: Request your medical records from previous appointments and hospital visits, if applicable. This information will help your healthcare provider understand your medical history and provide appropriate care.
- Make a list of symptoms: Write down any symptoms you are experiencing, including those that may seem unrelated to lupus or kidney problems. This information will help your healthcare provider understand the full extent of your condition.
- Prepare personal information: Note down any major stresses, recent life changes, or family medical history that may be relevant to your condition. This information can help your healthcare provider understand your overall health and well-being.
- List all medications: Create a list of all medications, vitamins, or supplements you are taking, including the doses. This information is important for your healthcare provider to review to ensure there are no potential interactions or complications with your current medications.
- Consider bringing a support person: It can be helpful to bring a family member or friend along to your appointment for emotional support and to help you remember important information discussed during the appointment.
- Prepare questions: Write down a list of questions to ask your healthcare provider during the appointment. Some questions to consider include:
- What's the most likely cause of my symptoms?
- Are there any other possible causes?
- What tests do I need to diagnose or monitor lupus nephritis?
- What treatment options are available for lupus nephritis?
- How often should I have follow-up appointments?
- What lifestyle changes or medications can I expect to manage lupus nephritis?
- Are there any support groups or resources available for managing lupus?