Lupus Nephritis

Lupus nephritis is kidney inflammation caused by systemic lupus erythematosus (SLE). Immune complexes lodge in the glomeruli and set off inflammation. It affects up to half of people with lupus, usually within the first 5 years, and more often and more severely in people of African, Asian and Hispanic ancestry.

It frequently causes no symptoms at first, which is why everyone with lupus needs regular urine testing. A biopsy assigns a class from I to VI. Classes III, IV and V need immunosuppression, and early, complete response to treatment is the best predictor of keeping your kidneys.

Symptoms

• Often none; protein or blood detected on a routine urine check
• Foamy urine
• Swelling of ankles, legs or around the eyes
• New or worsening high blood pressure
• Weight gain from retained fluid
• Lupus features flaring at the same time: joint pain, rashes, mouth ulcers, fatigue, fever
• Reduced urine output in severe flares

Causes and risk factors

Lupus arises from a combination of genetic susceptibility, hormonal influence (9 in 10 patients are women) and triggers such as sunlight, infections and certain medicines. Antibodies against the body's own DNA form complexes that deposit in the kidney filters and activate complement. Risk of kidney involvement is higher with younger age at lupus onset, male sex, high anti-dsDNA levels and low complement. Flares may follow stopping medication, pregnancy or infection.

How it is diagnosed

• Urinalysis and protein to creatinine ratio: Checked every 3 to 6 months in all lupus patients. Persistent protein above about 0.5 grams a day warrants biopsy.
• Creatinine and eGFR: Track filtering function.
• Anti-dsDNA and complement C3, C4: Rising antibody and falling complement levels often accompany a flare.
• Antiphospholipid antibodies: Identify clotting risk that affects kidneys and pregnancy.
• Kidney biopsy: Essential. It gives the ISN/RPS class and scores of activity versus chronic scarring, which decide how intensive treatment should be.
• Repeat biopsy: Sometimes used when response is poor or before stopping treatment.

Treatment options

• Hydroxychloroquine: Recommended for everyone with lupus nephritis; it lowers flare rates. Annual eye screening is needed after 5 years.
• Induction therapy: Corticosteroids with mycophenolate, or low dose intravenous cyclophosphamide (Euro-Lupus regimen), for classes III and IV over about 6 months.
• Add-on belimumab or voclosporin: Both improve kidney response rates when added to standard therapy. Obinutuzumab is a newer option.
• Maintenance therapy: Mycophenolate or azathioprine for at least 3 years, with steroids tapered to the lowest dose possible.
• Kidney protection: ACE inhibitor or ARB, blood pressure control, statin and salt reduction.
• Bone, infection and fertility protection: Vitamin D, vaccinations, pneumocystis prophylaxis where indicated, and fertility discussion before cyclophosphamide.
• Dialysis and transplant: For the minority who reach kidney failure. Lupus activity often quietens, and transplant outcomes are comparable to other causes.

When it is urgent

Seek emergency care locally for fever while on immunosuppression, sudden severe swelling, breathlessness or chest pain, very high blood pressure with headache or confusion, seizures, a painful swollen leg, or a marked fall in urine output.

Travelling to Türkiye for treatment

Treatment lasts years and requires blood and urine checks every 2 to 8 weeks at the start, prompt access when infection strikes and coordination between rheumatology and nephrology. That must be local. A visit can contribute a kidney biopsy with specialist pathology, a second opinion on a regimen that is not working, or pre-pregnancy planning. Avoid long flights during an active flare or heavy proteinuria, when clot risk is raised.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions