Lupus nephritis develops when systemic lupus erythematosus (SLE) — the most common form of lupis — damages the kidneys. Lupus causes the immune system to attack different parts of the body. If the immune system attacks the kidneys, it can lead to lupus nephritis.

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If you or a loved one is living with lupus nephritis — or lupus in general — it’s important to understand who develops the condition, what it looks like, how it can affect you, and how to best manage it. Here are eight facts about lupus nephritis.

1. Lupus Nephritis Is a Kidney Condition

Lupus is an autoimmune disease where the immune system produces autoantibodies. Normal antibodies are important in fighting infections, but in autoimmune diseases, autoantibodies mistakenly attack the body. When autoantibodies in lupus attack the kidneys, this can lead to lupus nephritis, which can vary in severity based on its class.

In lupus, when these autoantibodies attack, they can cause damage over time. They can also directly attack the kidney tissue, leading to inflammation. An inflamed kidney may struggle to do its job, like filtering waste and balancing the fluids in your body.

Classes of Lupus Nephritis

Lupus nephritis can be categorized into six classes, or stages. These classes are determined by the results of a kidney biopsy. This involves removing a very small sample of a person’s kidney tissue. A doctor will use the biopsy to look at the amount of kidney damage that has occurred. Specifically, they look at the damage to the glomeruli in the kidneys. Glomeruli are structures in the kidney made of tiny blood vessels that filter out waste from the bloodstream.

The classes of lupus nephritis are described as:

• Class 1 — There is little disease involvement in the kidney.
• Class 2 — There is some inflammation in the kidneys.
• Class 3 — Less than half of the glomeruli are affected by nephritis.
• Class 4 — More than half of the glomeruli are affected by nephritis.
• Class 5 — Structures in the kidney thicken, resulting in damage. Deposits of autoantibodies are found around the glomeruli, beneath the glomerular basement membrane (a thin kidney filter that separates blood from urine).
• Class 6 — More than 90 percent of the glomeruli are damaged.

2. About Half of Adults With Lupus Develop Lupus Nephritis

It’s fairly common for a person living with lupus to develop lupus nephritis. Around 50 percent of adults with lupus will develop lupus nephritis. Children with lupus are even more likely, with around 80 percent developing lupus nephritis.

Scientists believe that gender and race or ethnicity can play a role in determining who is likely to develop lupus nephritis. Around 90 percent of those living with lupus are women, according to the Lupus Foundation of America. However, men are more likely to have lupus nephritis. Additionally, there are higher rates of lupus nephritis in Black, Hispanic, and Asian American people than in white people.

3. Lupus Nephritis Is Hard To Prevent but Treatable

Generally, lupus nephritis can be difficult to prevent in people with lupus. However, there’s a chance that taking medication that suppresses immune activity may reduce a person’s likelihood of developing lupus nephritis.

Most people with the lupus nephritis do well over the long term — though you may need to take medications for years and get regular checkups.

Most people with lupus nephritis do well over the long term — though you may need to take medications for years and get regular checkups.

4. Urine Changes Are Key Symptoms of Lupus Nephritis

If you’re living with lupus and notice changes to your urine, lupus nephritis may be the culprit. People with the condition have urinary changes like foamy urine, which is caused by proteinuria (protein in the urine). They also may have hematuria (blood in the urine).

Other signs and symptoms of lupus nephritis include:

• Edema (swelling) of the hands, feet, ankles, legs, or face
• Hypertension (high blood pressure)
• Fever (in active systemic lupus erythematosus)
• A red rash covering the nose and cheeks (also called a butterfly rash, found in people with lupus)

Lupus nephritis symptoms can include changes in your urine, joint swelling, high blood pressure, fever, and a red rash.

If you develop any of these symptoms, check in with your nephrologist (kidney doctor) as soon as possible. They have several tools to test for lupus nephritis.

5. There Are Tests To Diagnose Lupus Nephritis

The condition is diagnosed using tests that analyze the blood, urine, and kidney tissue. These tests assess the kidney function, as well as any damage.

Lupus nephritis is diagnosed using tests that analyze the blood, urine, and kidney tissue.

Urine Test

The damage to the glomeruli during lupus nephritis leads to extra protein leaking out into the urine. A doctor can order an analysis of the protein levels in someone’s urine to determine if they have lupus nephritis.

Blood Test

Creatinine is a waste product produced by the natural breakdown of the muscles. When the kidneys are working properly, they will filter creatinine out of the blood and into the urine. Your doctor may order a blood test to look for excess levels of creatinine in the blood to help diagnose lupus nephritis.

Kidney Biopsy

Sometimes, a kidney biopsy is needed to diagnose lupus nephritis. This procedure is usually done in a hospital or an outpatient center under light sedation or general anesthesia. Once the biopsy is completed, a pathologist, a doctor who specializes in looking at tissue under a microscope, will examine the tissue to look for damage caused by lupus nephritis.

6. There Are Treatments Available for Lupus Nephritis

There’s no cure for lupus nephritis, but treatments can help reduce symptoms and prevent the condition from progressing. People with lupus nephritis can have a positive prognosis (outlook) with treatment.

Treatments for lupus nephritis usually aim to calm the immune system and reduce inflammation. Treatment approaches may also target the symptoms of lupus nephritis, such as swelling in the arms and legs and high blood pressure. Commonly prescribed medicines include immunosuppressive drugs and blood pressure medications.

7. Up to 30 Percent Develop Kidney Failure

Left untreated, lupus nephritis can lead to severe complications. Among them is long-term kidney damage. As lupus nephritis progresses and kidney function gets worse, end-stage renal disease (ESRD) — also called kidney failure — may occur. Between 10 percent and 30 percent of people with lupus nephritis will develop ESRD. People with ESRD will need a kidney transplant or dialysis. Dialysis is a medical procedure that helps remove waste from the blood.

Proliferative nephritis (classes 3 and 4) is the most severe form of lupus nephritis. It causes scars in the tissue of the kidneys. These scars affect kidney function, which worsens as scarring builds up.

People with lupus nephritis have a greater chance of heart and blood vessel problems. They may also be at higher risk for some kinds of cancer, including B-cell lymphoma.

8. Changes in Diet Can Help Manage Lupus Nephritis

If you have lupus nephritis, your doctor may suggest changes to what you eat. For example, they may tell you to cut back on salt or limit foods that are high in potassium or phosphorus. They may also suggest limiting your protein, such as meat and dairy products.

Everyone with lupus nephritis is different. Before you make changes to your diet, talk to your doctor to see what they recommend.

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On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.

What facts do you know about lupus nephritis? Let others know in the comments below.