How Quickly Does Lupus Nephritis Progress?

Lupus nephritis is a kidney disease caused by systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that causes the body’s immune system to mistakenly attack its own organs and tissues, causing inflammation and pain, commonly in the skin, joints, kidneys, and brain, and may be fatal. When SLE affects the kidneys, it is called lupus nephritis. 

Lupus nephritis tends to develop within 5 years of the appearance of initial lupus symptoms. The condition affects about 40% of people who have SLE and can lead to end-stage kidney disease (ESKD) in 22% of patients over a period of 15 years. 

Certain factors are associated with a more rapid progression of lupus nephritis to end-stage kidney disease: 

• Ethnicity: African Americans tend to have a poorer prognosis 
• Younger age
• Male sex
• Diffuse proliferative lupus nephritis
• Impaired kidney function at diagnosis
• Nephrotic range protein in the urine (proteinuria)
• Poor response to immunosuppressive therapy
• High blood pressure (hypertension)
• Diabetes
• Obesity

The following are the signs and symptoms of lupus nephritis:

• Protein in the urine (proteinuria)
  • Urine may be foamy, bubbly, or frothy
• Blood in the urine (hematuria)
  • Urine may appear pink or light brown
• Fluid retention (edema) 
  • Swelling in the legs, ankles, or around the eyes
• High blood pressure (hypertension)
• Weight gain
• Kidney problems
  • Joint pain or swelling
  • Fever with no known cause
  • Muscle pain
  • Red rash, often on the face, across the nose and cheeks (called a "butterfly rash" due to its shape)

Lupus nephritis is diagnosed with patient history and physical examination, as well as the following tests:

• Urine test to check for protein and blood
• Blood tests
  • Antiphospholipid antibodies  
  • Protein levels
  • Cholesterol
  • Glomerular filtration rate (GFR) which shows how well the kidneys filter waste
  • Antinuclear antibodies (ANA) 
• Kidney biopsy

Lupus nephritis is treated with the following medications:

• Corticosteroids, such as prednisone
• Immunosuppressive drugs, such as cyclophosphamide (Cytoxan) or mycophenolate mofetil (CellCept)
• Blood pressure medications
  • Angiotensin converting enzyme (ACE) inhibitors 
  • Angiotensin receptor blockers (ARBs)
  • Beta-blockers
  • Calcium channel blockers
  • Diuretics
  • Other blood pressure medications
• Antimalarials such as hydroxychloroquine (Plaquenil)
• Some chemotherapy drugs
• Diet changes
  • Reducing salt (sodium) 
  • Reducing protein