Lupus and the Kidney Disease, Lupus Nephritis: An Expert’s View

The reason why kidney disease strikes a lot of people with lupus has to do with the kind of disease lupus is, according to a Texas kidney expert who was interviewed about the connection between the conditions.

Lupus is an autoimmune disease. The immune system produces antibodies to counter such a disease, but the antibodies can end up attacking the kidneys and other organs, according to Dr. Rajeev Raghavan of the Baylor College of Medicine.

There is no way to prevent an autoimmune attack on the kidneys, so 40 percent of lupus patients develop a kidney disease called lupus nephritis, he said. The good news is that treatment is effective for 90 to 95 percent of patients, he added.

Doctors detect kidney disease by examining urine for blood or protein. Blood in urine suggests  kidney malfunction, as does a high level of certain proteins.

“When you have lupus nephritis the treatment is quite effective – only about 5 to 10 percent of those patients will progress on to really advanced kidney failure where they need dialysis or a kidney transplant,” Raghavan said in a news story by Julia Bernstein of the Baylor College of Medicine.

“Once the initial signs of kidney disease appear, the final diagnosis requires a kidney biopsy,” Raghavan said. Doctors analyze a sample of kidney tissue to determine the type and severity of the condition.

Once doctors know the specifics, they can develop a personalized treatment plan for a patient.

“Early diagnosis and treatment results in a high success rate in the sense that very few treated patients will require dialysis or transplantation,” Raghavan said.

There are two courses of treatment for lupus nephritis.

One is for patients with a less damaged kidney. The treatment is identical to that prescribed for any patient with a kidney condition. It includes restricting sodium to 2.3 grams per day and controlling a patient’s blood pressure to reduce it to 130 over 80 over less. When necessary, medication can be added to reduce hypertension.

The second treatment plan is for patients with more severe cases of lupus nephritis. In these cases, doctors prescribe medication to affect the immune system. Such drugs can carry severe side effects, but Raghavan said they are commonly used to treat patients with severe kidney damage due to lupus, and they are well tolerated.

“All we know is that if you have kidney disease because of lupus, we have medications to control and treat the disease,” he concluded.