Lupus Nephritis – Diagnosis and Treatment

Diagnosis

Diagnosing lupus nephritis usually involves several steps. The goal is to understand how much the kidneys are affected and what type of treatment will help most.

• Blood tests check kidney function, serum creatinine levels, and reveal markers linked to systemic lupus erythematosus, like antinuclear antibodies (ANA) or anti-double-stranded DNA antibodies. High levels of creatinine can signal reduced kidney filtering ability.
• Urine tests detect proteinuria (protein in the urine) or hematuria (blood in the urine), which are signs of kidney problems. A 24-hour urine test may also be used to measure how much protein is being lost.
• A kidney biopsy lets doctors look at kidney tissue under a microscope to measure organ damage, disease activity, and classify the type of glomerulonephritis present. This is the most accurate way to determine the severity and stage of the disease.

Doctors may also check complement levels (C3, C4) in the blood, which are often low during lupus flares, and perform imaging tests like ultrasounds to examine kidney size or swelling.

Treatment

General Support and Lifestyle Adjustments

People with lupus nephritis often benefit from changes to their daily habits. Eating less protein and using less salt can lower the strain on the kidneys. Keeping blood pressure controlled is also important.

Doctors may suggest ACE inhibitors or angiotensin II receptor blockers (ARBs), which help both control blood pressure and reduce protein loss in urine. Sometimes, diuretics remove extra fluid from the body.

Drug Treatments

Doctors use several types of medications to manage lupus nephritis. Treatment usually combines medicines that suppress the immune system to reduce inflammation and protect kidney function.

• Corticosteroids help control swelling and quickly reduce immune activity during flares. These drugs are often used at the start of treatment to bring the disease under control.
• Immunosuppressive agents are used to reduce the immune system’s attack on the kidneys. These include medications that block immune cell growth or interfere with how antibodies are made. Examples include agents from the antimetabolite, alkylating agent, or calcineurin inhibitor classes.
• Doctors often include disease-modifying antirheumatic drugs (DMARDs) to help balance immune activity and reduce long-term damage. These medicines may be continued during periods of low disease activity to prevent flares.

Treatment is typically divided into two phases:

1. Induction treatment: Stronger immunosuppressive therapy is given to reduce kidney inflammation quickly and stop the damage from progressing.
2. Maintenance treatment: Once symptoms improve, doctors lower the dose or switch to milder medications to maintain kidney function and reduce the risk of side effects.

This step-by-step plan helps stabilize the condition while minimizing harm from long-term drug use. Doctors monitor treatment closely with blood and urine tests and may adjust the dose or switch medications if the person does not respond or develops side effects.

Advanced Care When Kidneys Fail

If lupus nephritis leads to kidney failure, doctors provide stronger support. Dialysis removes waste and extra fluid from the blood. This helps with symptoms and keeps the body’s minerals balanced.

If dialysis cannot keep a person healthy, a kidney transplant from a donor may replace the kidneys that are not working. Ongoing care after transplant helps prevent the disease from returning.

Get Ready for Your Visit

Preparing for your health appointment helps your medical team understand your condition and create the best plan for treatment.

What You Can Do

• Track your symptoms. Note things like swelling, fatigue, foamy urine, or changes in urination patterns. Write down when they started and if they’re getting better or worse.
• Keep a list of medications. Include all prescription drugs, over-the-counter pills, and supplements you take. This helps prevent harmful drug interactions.
• Bring medical records. If you’ve had past lab work, imaging, or biopsy results, share them with the care team.
• Note questions you want to ask. Here are some examples:
  • What stage of lupus nephritis do I have?
  • How will treatment affect my daily life?
  • Are there warning signs that mean I should seek help right away?
  • What foods or habits should I avoid?
  • Will I need dialysis or transplant in the future?

What the Doctor May Ask

Doctors will gather as much information as possible to evaluate your condition:

• Have you noticed swelling, changes in urine, or pain?
• Do you have high blood pressure or other health conditions?
• Have you missed any medications recently?
• Are you able to follow a low-sodium or low-protein diet?
• Have you had recent lupus flares in other parts of the body?

Being honest and prepared helps your provider give the best care. Bringing a support person or writing down instructions during the visit can also help you remember next steps more clearly.