Lupus nephritis

Diagnosis

Several tests may be required to confirm the diagnosis, such as:

• Physical examination: Healthcare provider will discuss the signs and symptoms, and evaluate one’s medical history are all necessary in the diagnosis of lupus nephritis.
• Blood and urine tests: These tests assess how effectively the kidneys are functioning. Antibody blood tests look for elevated quantities of proteins produced by the immune system. A urinalysis looks for wastes and other unusual substances in the urine, including protein. One may be asked to collect the urine for an entire day in addition to regular blood and urine testing.
• Kidney biopsy: A biopsy can help the doctor identify the severity of the kidney impairment. A small part of kidney tissue is extracted for laboratory examination. This procedure is considered as the most conclusive diagnostic for lupus nephritis.

Treatment

The treatment for lupus nephritis usually aims to manage the condition, since no definite cure is available. Specifically, the goal of the treatment is to reduce or eliminate symptoms, prevent the condition from worsening, retain remission, and avoid the need of dialysis or a kidney transplant. Several treatment options are available ranging from conservative to aggressive procedures.

• Conservative treatments: The healthcare provider may start with medications and lifestyle changes as part of the initial treatment:
  • Diet changes: With the help of a nutritionist, building a healthy diet suited for one’s unique needs may be beneficial. Eating less protein, such as meat and dairy, and lowering salt intake can also help the kidneys perform more efficiently.
  • Blood pressure medications: Diuretics are medications that can help get rid of excess fluid. Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) are blood pressure medications that assist regulate blood pressure and minimize protein loss.
• Medication: Corticosteroids and immunosuppressive drugs can block the immune system from attacking the kidney blood vessels. Prednisone and other steroids, cyclosporine, tacrolimus, cyclophosphamide, azathioprine, mycophenolate, rituximab, and belimumab may be prescribed for severe cases of lupus nephritis.

The healthcare provider may discuss the benefits and side effects of each drug and determine which medication is the most beneficial. Several clinical trials are ongoing for new drugs for this condition.

• Treatment options for kidney failure: Kidney failure occurs in 10% to 30% of lupus nephritis patients. Advanced stage of lupus nephritis may require a more extensive treatment, such as:
  • Dialysis: This is a process that cleans the blood when the kidneys are not performing properly. By filtering the blood through a machine, dialysis helps maintain the proper balance of minerals in the blood, regulate blood pressure, and eliminate fluid and waste from the body. Two types of dialysis include hemodialysis and peritoneal dialysis.
  • Kidney transplant: A kidney transplant is a medical operation in which one of the failing kidneys is replaced with a healthy kidney from a donor.