Lupus nephritis

• What is Lupus Nephritis
• Statistics on Lupus Nephritis
• Risk Factors for Lupus Nephritis
• Progression of Lupus Nephritis
• Symptoms of Lupus Nephritis
• Clinical Examination of Lupus Nephritis
• How is Lupus Nephritis Diagnosed?
• Prognosis of Lupus Nephritis
• How is Lupus Nephritis Treated?
• Lupus Nephritis References

What is Lupus Nephritis

Lupus nephritis is a disease affecting the kidneys. It occurs as a complication of Systemic Lupus Erythematosus (SLE), a systemic autoimmune disorder.

Statistics on Lupus Nephritis

Lupus nephritis only affects people with SLE. It is a common complication of SLE. A US study reported 40.5% of African Americans with SLE had lupus nephritis at any given time and 15.3% had end stage kidney disease, that is severe lupus nephritis leading to death. African-Americans with SLE developed lupus nephritis at a younger age than their Caucasian counterparts. Amongst Caucasians with SLE 4.5% had lupus nephritis and 18.8% had end stage kidney disease at any given time.

Lupus nephritis is one of the main causes of death in people with SLE. In Asia-Pacific countries kidney disease is the cause of death in 7-36% of people with SLE, depending on the country. Lupus nephritis is more common in Asians with SLE compared to Caucasians.

Risk Factors for Lupus Nephritis

The only known predisposing factor is the presence of SLE, which has the sole predisposing factor of family history.

Progression of Lupus Nephritis

The natural history of this condition is not yet fully understood. Early in the disease process, the condition is usually silent with only one-half experiencing clinical symptoms. It is generally held that mild forms of lupus nephritis will progress to more severe and symptomatic forms in about 5% of patients. With progression of the nephritis, the tubules of the kidney may also become involved and renal failure may ensue. In a minority of cases, tubular involvement tends to be the predominant feature.

Only 20% of patients will have lupus nephritis at the time of diagnosis. Over the next 10 years, the rate of renal involvement steadily increases. After ten years, the onset of new renal disease from lupus nephritis is greatly reduced.

In rare cases, lupus nephritis may be the only consequence of SLE.

How is Lupus Nephritis Diagnosed?

General investigation of SLE will require a number of blood tests to be completed. There are specific markers present in the blood which idenifty SLE disease.

Prognosis of Lupus Nephritis

The prognosis of this condition is strongly associated with the appearance of the kidney beneath the microscope. The mild forms of disease are associated with a good prognosis, with most mainatining good kidney function. When more severe forms are present, the patient will be more likely to develop renal failure and will therefore carry a poorer prognosis.

How is Lupus Nephritis Treated?

There are two phases of treatment, which reflect the two stages of disease.

Induction phase

Initial treatment is guided by the results of blood and biopsy tests. The main drugs used are steroids, which are commonly used alone for lesser forms of the disease. These are combined with more potent drugs (with more side-effects but better action) when more severe types of lupus nephritis are identified.

Maintenance therapy

Patient are required to take anti-inflammatory drugs over a long period time (greater than 10 years) in order to prevent recurrence of their lupus nephritis. Steroids are the mainstay again for maintenance therapy. Most patients cease therapy after five years, as instructed by their doctor who is guided by regular urine and blood testing.

Lupus Nephritis References

1. National Institute of Diabetes and Digestive and Kidney Diseases. Lupus Nephritis. 2014. [cited 7 October 2015]. Available from: [URL Link]
2. Somers EC, Marder W, Cagnoli P, et al. Population-based incidence and prevalence of systemic lupus erythematosus: the Michigan Lupus Epidemiology and Surveillance program. Arthritic Rheumatol. 2014; 66(2):369-78. [Abstract]
3. Jakes RW, Bae S, Louthrenoo W, et al. Systematic Review of the Epidemiology of Systematic Lupus Erythematosus in the Asia-Pacific Region: Prevalence, Incidence, Clinical Features and Mortality. Arthritis Care Res. 2012; 64(2): 159-168. [Full Text]
4. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001. [Book]
5. Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999. [Book]
6. Longmore M, Wilkinson I, Torok E. Oxford Handbook of Clinical Medicine. Oxford University Press. 2001. [Book]