Patient education: Lupus and kidney disease (The Basics)

What does kidney disease have to do with lupus? — People with lupus are much more likely to have kidney disease than people who don't have lupus. The kidneys are organs in the urinary tract that filter the blood and make urine (figure 1). Kidney disease can cause swelling, high blood pressure, and other symptoms.

"Lupus nephritis" is the medical name for a type of kidney disease that happens in people with lupus. People who have lupus can also get kidney disease caused by other problems. As an example, if someone with lupus also has diabetes, the diabetes might be the cause of kidney problems.

What are the symptoms of lupus nephritis? — Although some people with lupus nephritis don't have symptoms, about half of all people with lupus do. Symptoms can include:

●Swelling – This can be in the hands, face, feet, belly, or around the eyes.

●Weight changes – Many people gain weight, but some people lose weight without trying to.

●Tiredness

●Urine that looks brown or foamy

●Urinating less often than normal

●High blood pressure (higher than 130/80)

Is there a test for lupus nephritis? — Yes. If you have lupus, your doctor or nurse will do regular blood and urine tests to check for signs of lupus nephritis. You might also have a test called a "biopsy." In this test, a doctor takes a small sample of kidney tissue. Another doctor looks at the sample under a microscope to check for kidney disease.

How is lupus nephritis treated? — Medicines are usually the first treatment for lupus nephritis. These include:

●Medicines to partly "turn off" the immune system – In lupus, the body's immune system attacks healthy cells. Medicines that partly turn it off can slow down the damage lupus causes in the kidneys. There are many different medicines doctors use to treat the immune system. The doctor might:

•Try 1 or 2 medicines to see which works best

•Give you more than 1 medicine at a time

•Have you switch to a different medicine when the lupus nephritis is under control

●Medicines called "ACE inhibitors" or "angiotensin receptor blockers" – These medicines can help with kidney damage from lupus nephritis.

Severe lupus nephritis can make the kidneys stop working. If this happens, treatment options include:

●Hemodialysis, often called "dialysis" – A machine filters your blood every few days (figure 2).

●Peritoneal dialysis – A fluid is piped in and out of your belly every day (figure 3).

●Kidney transplant – Doctors replace your kidneys with a healthy kidney from a donor (figure 4). (People only need 1 working kidney to live.)

What if I want to get pregnant? — Getting pregnant when you have lupus nephritis can be risky. It can increase the chance that the unborn baby will die before birth. Being pregnant can also make lupus nephritis worse.

If you want to get pregnant, talk to your doctor or nurse before you start trying to get pregnant. There are ways to reduce the chances of having problems. For example, it is important to wait until you have not had lupus nephritis symptoms for at least 6 months. Your doctor can work with you to try to make this happen.

What will my life be like? — People with lupus must take medicine to control the symptoms and slow down the disease. This is true for people with lupus nephritis, too. Lupus nephritis sometimes goes away on its own. Other times, symptoms come back after treatment. Your doctor or nurse will work with you to treat them if this happens to you.

More on this topic

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Patient education: Glomerular disease (The Basics)
Patient education: Lupus (The Basics)
Patient education: Lupus and pregnancy (The Basics)

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