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Lupus Nephritis: Symptoms

Updated on March 07, 2022
Medically reviewed by
Walead Latif, D.O.
Article written by
Amanda Agazio, Ph.D.

  • The symptoms of lupus nephritis are associated with the kidney damage that occurs during the disease.
  • Symptoms such as foamy urine and blood in the urine may indicate an issue with your kidneys.
  • A doctor may detect signs of lupus nephritis disease activity with blood and urine tests, blood pressure monitoring, and in some cases, a kidney biopsy.

Lupus nephritis is a kidney condition that causes symptoms like foamy urine, blood in the urine, and swelling of the legs, hands, or face. It’s caused by the autoimmune disease systemic lupus erythematosus, often simply called lupus. Lupus occurs when a person’s immune system attacks their body and its tissues, which can lead to kidney damage. This damage affects important kidney function, including filtering waste and excess fluid out of the blood and into the urine.

Signs and Symptoms of Lupus Nephritis

During lupus nephritis, small blood vessels in the kidney, known as glomeruli, become damaged by the immune system. The glomeruli pull waste out of the blood and into the urine. Many symptoms of lupus nephritis are associated with damage to the kidney and the glomeruli.

Foamy Urine

The urine can appear foamy in people with lupus nephritis due to excess protein. This condition is known as proteinuria. The damage that occurs to the glomeruli during lupus nephritis can allow protein from the blood to leak into the urine.

Blood in the Urine

When the urine is a light brown or pink color, it may contain blood. This condition is referred to as hematuria. Blood can leak into the urine when the glomeruli are damaged.

Swelling in the Legs, Hands, and Face

Besides removing waste from the blood, kidneys also remove excess fluid from the body. When the kidneys are damaged, fluid can accumulate in places such as the legs, ankles, hands, and face. Swelling can also appear around the eyes. This accumulation of excess fluid is commonly referred to as edema.

Weight Gain

People with lupus nephritis may gain weight because they are retaining fluid.

Frequent Urination

Frequent urination, especially during the night, is another common symptom of lupus nephritis. Peeing often can serve as an indication that the kidneys are not working properly.

Tests for Signs of Lupus Nephritis

Lupus nephritis is a common condition that occurs in up to 50 percent of people living with lupus. Your doctor should monitor you for signs of lupus nephritis. They will run tests on the urine and blood, and they may even want a biopsy of the kidney tissue. The results of these tests may indicate the presence of lupus nephritis.

High Levels of Creatinine in the Blood

If a doctor detects high levels of creatinine in the blood of someone living with lupus, it could indicate lupus nephritis. Creatinine is a natural waste product created by the breakdown of muscles in the body. Properly functioning kidneys should filter this waste out of the blood and into the urine.

High Blood Pressure

The kidneys play a role in controlling blood pressure. Kidney damage resulting from lupus nephritis can affect the organ’s ability to regulate blood pressure, leading to high blood pressure.

Damage Detected by Kidney Biopsy

If a doctor suspects you have lupus nephritis, they may want to perform a kidney biopsy. This procedure involves taking a very small piece of tissue from the kidney and examining it under a microscope. A kidney biopsy is performed under light sedation or general anesthesia, often in a hospital or outpatient center.

Are you living with lupus nephritis?
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Measuring Lupus Nephritis Progression

There are six stages or classes of lupus nephritis. As the disease worsens, the stages progress. A doctor can identify lupus nephritis stages based on a kidney biopsy and a person’s kidney function.

Some people living with lupus nephritis will progress to chronic kidney disease (CKD). If more damage occurs and kidney function gets worse, some people may progress from CKD to end-stage renal disease (ESRD). Up to 30 percent of people with lupus nephritis will develop into ESRD. People with ESRD generally require dialysis or a kidney transplant.

The following symptoms or signs of CKD and ESRD may indicate a person’s kidney function is getting worse:

  • Shortness of breath
  • Fatigue
  • Difficulty falling and staying asleep
  • Itchy skin
  • Headaches
  • Muscle cramps
  • Nausea
  • Erectile dysfunction

A doctor may also be able to tell that lupus nephritis is getting worse by running tests on the blood and urine. A doctor can also assess kidney damage by taking a biopsy of the kidney tissue and analyzing it under a microscope.

Fortunately, treatments for lupus and lupus nephritis can slow the disease’s progression and limit damage to the kidneys. Taking certain medications, along with living a healthy lifestyle that supports the kidneys, can benefit many people living with lupus nephritis.

When To Call Your Doctor

You should talk to your doctor if you are experiencing any of the signs and symptoms of lupus nephritis, CKD, or ESRD. You should also talk to your doctor if you notice your symptoms of lupus nephritis getting worse, which could indicate the disease is progressing. You may require changes to your treatment plan or a different kind of therapy, such as dialysis.

People with lupus nephritis are at higher risk for heart and blood vessel problems. Heart failure is a major complication of kidney disease, as are other conditions associated with the heart. If you suspect you are experiencing the symptoms of a heart attack — including chest pain and shortness of breath — get emergency help right away.

Connect With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Are you living with lupus nephritis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Walead Latif, D.O. specializes in dialysis access management as an interventional nephrologist. Review provided by VeriMed Healthcare Network . Learn more about him here.
Amanda Agazio, Ph.D. completed her doctorate in immunology at the University of Colorado Anschutz Medical Campus. Her studies focused on the antibody response and autoimmunity. Learn more about her here.

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