Lupus Nephritis – When Kidneys Get Involved

 

 

Lupus is a systemic autoimmune disease which can affect multiple organs. As a result, lupus braves often face a number of unique challenges. One of the most commonly affected organs, which will require additional treatments if involved, are the kidneys. This type of lupus is called lupus nephritis or glomerulonephritis. Lupus nephritis occurs when the immune system causes inflammation and damage within the kidneys. The kidneys’ glomeruli become inflamed and scarred. Over time they may lose their ability to remove wastes and excess fluid from the body. 

 

Lupus nephritis is a fairly common condition, it impacts almost 45% of people with lupus and rates of occurrence are higher in certain ethnic groups. Rates of occurrence are highest amongst Blacks, Asians, Native Americans, and Hispanics as compared to Caucasian lupus patients. These trends may exist due to socioeconomic differences and barriers to healthcare access. The management of lupus and its many symptoms requires an ongoing and healthy relationship between patients and providers. It also depends upon careful collaboration between healthcare teams. Rheumatologists and nephrologists are critical in the management of lupus nephritis. 

 

Symptoms of lupus nephritis

  • Changes in urine – foamy, bloody, and may be more or less frequent
  • Edema – swelling in face, hands, belly, feet. 
  • High blood pressure
  • Joint and muscle pain 
  • Fever
  • Changes in urinary frequency

 

It has become common practice amongst rheumatology experts to screen their lupus patients for kidney involvement. This is done through routine urine tests. If additional investigation is required, a blood test, ultrasound, or kidney biopsy may be performed to further confirm diagnosis. 

 

A kidney biopsy is a crucial part of the diagnostic and classification process. Continued support for its use in diagnosis remains amongst disease experts. The biopsy allows your healthcare provider to further classify your condition and provide better treatment options. Although it sounds like a complicated and invasive procedure, it actually is not. Technology and modern techniques have improved the process greatly. You should feel like yourself and be back on your feet within 24 hours. 

 

Results of kidney biopsy allows lupus nephritis to be classified and staged as: 

  • Class I – minimal mesangial involvement
  • Class II – some mesangial involvement  
  • Class III – involves less than 50% of all glomeruli
  • Class IV – involves 50% or more of all glomeruli
  • Class V – involves glomeruli involvement throughout kidney
  • Class VI – advanced sclerosis of kidneys

 

The above is an overly simplistic description of a complex process. Your healthcare provider will be able to explain the details of your classification with additional necessary details. Treatment decisions and therapy outcomes are greatly affected by the category you fall into. 

 

By Nadia Bhatti

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