Lupus Nephritis

Systemic lupus erythematosus — more commonly known as lupus — is an autoimmune disease in which your immune system produces proteins called autoantibodies that attack your own tissues and organs. Some people with lupus develop a form of kidney inflammation called lupus nephritis.
Lupus nephritis occurs when lupus autoantibodies affect the filtering structures (glomeruli) of your kidneys. This abnormal process results in kidney inflammation and may lead to blood in the urine (hematuria), protein in the urine (proteinuria), high blood pressure, impaired kidney function or even kidney failure.
What causes lupus?
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. About 1.5 million Americans have lupus.
What are the symptoms of lupus?
Different people get different symptoms. These may include skin rashes, joint pain, hair loss, sun sensitivity, tiredness, weight loss, fever, swelling of lymph glands, chest pain and nerve involvement.
Lupus Nephritis Diagnosis and Treatment
The diagnosis of lupus nephritis begins with a medical history, physical exam, and evaluation of symptoms. You doctor will likely order tests to make or confirm a diagnosis. Tests used in diagnosing kidney problems include urine tests, blood tests, imaging tests such as ultrasound, and kidney biopsy.
There are five different types of lupus nephritis. Treatment is based on the type of lupus nephritis, which is determined by the biopsy. Since symptoms and severity vary from person to person, treatments are individually tailored to meet a person's particular circumstances.
Medications used in treatment can include:
· Corticosteroids. These strong anti-inflammatory drugs can decrease inflammation. Doctors may prescribe these until the lupus nephritis improves. Because these drugs can cause a variety of potentially serious side effects, they must be monitored carefully. Doctors generally taper down the dosage once the symptoms start to improve.
· Immunosuppressive drugs. These drugs, which are related to the ones used to treat cancer or prevent the rejection of transplanted organs, work by suppressing immune system activity that damages the kidneys. They includecyclophosphamide (Cytoxan), azathioprine (Imuran[mmr1] ) and mycophenolate (Cellcept).
· Medications to prevent blood clots or lower blood pressure if needed
Even with treatment, loss of kidney function sometimes progresses. If both kidneys fail, people with lupus nephritis may need dialysis. Dialysis involves filtering the blood through a machine to remove waste products from the body.
Ultimately, it may be necessary to have a kidney transplant. In those cases, people will need additional drugs to keep their immune system from rejecting the transplanted kidney.
Lifestyle Changes for Lupus Nephritis
Certain lifestyle habits can help protect the kidneys. People with lupus nephritis should do the following:
· Drink enough fluids to stay well hydrated.
· Eat a low-sodium diet, especially if hypertension is an issue.
· Avoid smoking and drinking alcohol.
· Exercise regularly.
· Maintain a healthy blood pressure.
· Limit cholesterol.
· Avoid medications that can affect the kidneys, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Your doctor may also recommend that you eat a diet low in potassium, phosphorus, and protein if there is already loss of kidney function.

Although lupus nephritis is a serious problem, most people who receive treatment do not go on to have kidney failure.