Lupus nephritis: symptoms, treatment and complications

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Lupus nephritis

Lupus nephritis is an autoimmune disease that attacks the kidneys. Learn about the symptoms, treatment, and complications of lupus nephritis.

What are the symptoms of lupus nephritis?

If you have lupus and notice any of the symptoms below, talk to your healthcare provider about having your kidney health evaluated:

  • Weight gain
  • great tiredness
  • Joint pain
  • joint swelling
  • Dolor muscular
  • Fever for no apparent reason
  • Red rash on the face
  • High blood pressure
  • Needing to urinate frequently, especially at night
  • Foam or bubbles in the urine (indication that the urine contains protein)
  • Blood in the urine
  • Swelling of the legs, feet, ankles, and sometimes the hands and face

How will I know if I have lupus nephritis?

Only people who have lupus can get lupus nephritis. If your health care provider thinks that lupus might be affecting the kidneys, he or she may order  urinalysis  to see if there is blood or protein in the urine. The presence of blood or protein in the urine may indicate that the kidneys are not working properly. Your healthcare provider may also order a  blood test  to determine your creatinine level. Creatinine is a waste product derived from muscle activity. Having a high blood creatinine level is also an indication of a kidney problem.

If blood and urine tests indicate there might be a problem, your health care provider may want you to have a  kidney biopsy  to look for signs of lupus nephritis. A kidney biopsy is a procedure in which the doctor removes a small piece of your kidneys for careful examination under a microscope. The doctor checks it for signs of lupus nephritis, such as inflammation or fibrosis (scarring).

Sometimes healthcare providers don’t know right away that a person has lupus nephritis. The symptoms of lupus nephritis can resemble those of other diseases. Proper testing or diagnosis could take up to several years.

Who is at risk of lupus nephritis?

An estimated 1.5 million Americans have some form of lupus. About 1 in 2 adults with lupus will have lupus nephritis. The two main risk factors for developing lupus nephritis are biological sex and race/ethnicity.

  • Although 90% of people with lupus are women, men are more likely to have lupus nephritis than women.
  • The chance of developing lupus nephritis is also higher in racial or ethnic minorities, such as black or Asian Americans and Hispanics.

The risk is also higher in those who have a relative with lupus nephritis. If you have a family member with lupus, tell the doctor and ask if they need to be tested. Many experts believe that lupus is caused by a combination of genetic and environmental factors. For example, having the APOL-1 gene can increase the risk of kidney failure and lupus nephritis.

What is the treatment for lupus nephritis?

Treatment of lupus nephritis focuses on preventing further damage to the kidneys. Finding and treating lupus nephritis early can help prevent serious damage. Lupus damages the kidneys because it causes the immune system to attack them. To prevent this from happening, your health care provider may prescribe a medicine called an immunosuppressant. These are medicines that weaken the immune system so it can’t damage the kidneys as much.

Your healthcare provider may also prescribe a medicine to lower your blood pressure. High blood pressure is the second most common cause of  kidney failure  (end-stage renal disease, or ESRD). Two types of blood pressure medications that are commonly used are ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor antagonists). These drugs reduce the amount of protein in the urine and prevent further damage to the kidneys.

Excess fluid in the body can also increase blood pressure and put additional stress on the heart. If the body retains too much water, it may cause swelling in the legs or ankles or shortness of breath due to fluid in the lungs. The health care provider may prescribe a diuretic, which is a pill to make you urinate more. This medication may help you get rid of excess fluid that your body is holding. As a result, you may need to go to the bathroom more often, as the fluid is removed as urine.

Which doctors are on the lupus nephritis treatment team?

Lupus can affect many parts of the body, which is why the lupus treatment team is made up of different health professionals. Many people with lupus see a rheumatologist, which is a doctor who treats diseases of the immune system, joints, and muscles. When lupus begins to affect the kidneys and you are diagnosed with lupus nephritis, ask for a referral to a nephrologist (kidney doctor).

The treatment team is different for each person. Some other doctors you may see are: 

  • Cardiologists  who treat problems related to the heart and blood vessels. 
  • Dermatologists  who treat problems related to the skin, hair and nails.
  • Gastroenterologists  who treat problems related to the digestive tract and liver.
  • Neurologists  who treat problems related to the brain and nervous system.
  • Ophthalmologists  who treat problems related to the eyes and vision. They can operate on the eyes and prescribe glasses and contact lenses to correct vision problems. 
  • Pulmonologists  who treat problems related to the lungs and other parts of the respiratory system.
  • Perinatologists , who are specialists in maternal-fetal medicine and care for patients with high-risk pregnancies.

It is important that all members of the treatment team have up-to-date information about your health. Tell each doctor which other doctors you see. Tell them about your medical problems, the most recent test results, and the medicines you take. If your doctors are not part of the same network, it may not be easy for them to access this information. The more they know about your medical history, the better they can collaborate and coordinate your care.  

What are the complications of lupus nephritis?

Lupus nephritis can cause permanent kidney damage; that is, chronic renal failure (CRF). The most serious type of lupus nephritis, called proliferative nephritis, can cause scarring to form on the kidneys. These scars damage the kidneys and prevent them from working properly. Chronic kidney failure that worsens and causes the kidneys to stop working is called kidney failure or end-stage renal failure (ESRD). From 1 to 3 in 10 people with lupus nephritis end up with  kidney failure or ESRD .

People with lupus nephritis are also more likely to get certain types of cancer, heart problems, and blood vessel problems.

What resources are there that can help people cope with lupus nephritis?

A diagnosis of lupus can have a huge shock. It is a disease practically unknown to many people. The first step to obtaining the necessary care is to have an accurate diagnosis. Lupus is a forever disease, and for this reason it can have various repercussions in daily life for the rest of your days. Physical symptoms, frequent medical visits, and financial stress can affect emotional well-being. In people with lupus or lupus nephritis, mental health is just as important as physical.

Look for healthy ways to cope
It is normal to have stress, anxiety and depression when facing difficult situations. If you notice changes in your mental health, the following activities may help you feel better:

  • do meditation
  • Do deep breathing exercises
  • write in a journal
  • Talk to yourself in positive terms (eg, “I do my best”)
  • Exercising (walking, yoga, or resistance exercises)
  • Spend more time outdoors, in full light 
  • Try creative activities (such as painting, crafting, or sewing)
  • get enough sleep
  • Limit alcohol and caffeine 
  • draw on your faith

Talk to a professional
If you want to talk to a professional, ask a member of the treatment team to refer you to a mental health therapist, counselor, or social worker. 

They are trained professionals to help you: 

  • To understand and process emotions
  • To improve your coping skills 
  • To maintain healthy relationships with loved ones 
  • To attend to daily affairs derived from a chronic illness
  • To ask for attention to your needs

Many health insurance providers cover mental health services. Call your health insurance provider to find out what your health plan includes and for a list of mental health providers in your area.

Find a support group
Sometimes we feel isolated when we have a chronic illness like lupus nephritis. Remember that you are not alone. One of the best ways to cope with a major life change is to connect with people who are going through similar situations. 

Some benefits of joining a support group are: 

  • Being able to talk openly and honestly with people who understand what you are going through
  • Receive lupus management advice from people who have had lupus longer than you
  • Learn more about lupus nephritis and opportunities for patients
  • Finding new ways to cope with problems
  • Feeling empowered and supported by the new community you join
  • Make new friends

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