Lupus Nephritis Treatment in Delhi, India

Lupus nephritis is a common complication in people with systemic lupus erythematosus — more commonly known as lupus. Lupus nephritis is an autoimmune disorder that causes the immune system to produce proteins called auto-antibodies that attack the tissues and organs, specifically the kidneys.

Lupus nephritis occurs when lupus auto-antibodies start affecting the kidneys, causing inflammation. It may also lead to blood and protein in the urine, hypertension, and impaired kidney function. Kidney disease caused by lupus may worsen over time and lead to kidney failure. If the kidneys fail, dialysis or a kidney transplant will be the choice of treatment to maintain health and prolong lifespan.

Usually, individuals with Lupus Nephritis present the following signs and symptoms:

• Blood in urine
• High blood pressure or hypertension
• Swelling in the hands, ankles, or feet due to fluid retention
• Foamy urine because of excess protein in the urine
• High levels of serum creatinine
• Muscle pain
• Fever with no known cause
• Joint pain or swelling
• A red rash on the face, across the nose and cheeks, also called a butterfly rash because of its shape

If you are experiencing any of the symptoms listed above, it is important to consult with a doctor right away. Lupus nephritis is a serious condition, but it is treatable. With early diagnosis and treatment, most people with lupus nephritis can live long and healthy lives.

In lupus nephritis, antibodies attack the kidneys leading to inflammation and abnormal kidney function. Long-term inflammation leads to scarring and permanent kidney damage. The cause of lupus nephritis is systemic lupus erythematosus (SLE). However the cause of SLE is unknown, but it has been suggested that it could occur because of a combination of events that trigger the body's immune system to attack the kidneys. The events that lead to this faulty immune response are not clear, but researchers think they may be:

Genes: Very little evidence exists that particular genes directly cause lupus, but several genes may raise the risk for the disease. For example, people of specific ethnic descent, such as Hispanic, Asian, Pacific Island, Native American, and African, are more likely to get lupus, possibly due to shared genes.

Hormones: Lupus nephritis shows a female predilection. Its symptoms tend to increase before the menses and during pregnancy when oestrogen is high. However, medications with oestrogen, like birth control pills and hormone replacement therapy, don't increase the risk of lupus. Scientists are still figuring out the existence of any connection between hormones and lupus and why it occurs predominantly in women.

Environment: Some environmental factors that may affect causing lupus nephritis are:

• Cigarette smoke
• Mercury exposure
• Viruses such as Epstein-Barr, herpes zoster (causes shingles), and cytomegalovirus
• Silica, a mineral from the Earth's crust found in sand, stone, concrete, and mortar
• UV light
• Stress

Only adults and children with SLE can develop lupus nephritis. Some known risk factors for lupus nephritis include:

• Women are more likely to develop lupus nephritis
• Race: Black, Native American, Hispanic/Latino, Pacific Islander, or Asian descent.
• Exposure to certain infections, viruses, toxic chemicals, or pollutants in the environment
• Have a family history of the disease.
• Have another autoimmune disease.

In addition to renal failure, other long-term complications of lupus nephritis are:

• Higher risk of certain cancers, including B-cell lymphoma.
• Heart and blood vessel problems

Lupus nephritis can show up in various stages of severity. Determining the stages, therefore, is crucial as it helps guide treatment decisions and prognosis assessment. 

There are six recognized stages of lupus nephritis, each indicating different levels of kidney involvement and potential complications. The higher the stage of the disease, the more severe it is.

Stage 1

• Minor kidney damage
• No obvious other signs or symptoms

Stage 2

• Some evident damage to the kidneys
• Presence of blood and protein in the urine

Stage 3

• More than 50% damage to blood vessels in the kidney
• Higher amounts of blood or protein in the urine
• Possible hypertension

Stage 4

• Damage to more than 50% of blood vessels in the kidney
• Blood or protein in the urine
• Possible hypertension
• Possible need for dialysis as kidneys malfunction or stop working entirely

Stage 5

• Thickening of essential parts of the kidney
• Mostly protein in the urine
• Possible hypertension
• Failure of the kidney is possible

Stage 6

• Damage to more than 90% of renal blood vessels, which is chronic & irreversible
• Protein in the urine
• Possible hypertension
• Mostly requires dialysis or renal transplant

Diagnosis of lupus nephritis begins with the kidney specialist suggesting a thorough medical evaluation, including a review of the patient’s medical history, a physical examination, and an assessment of their symptoms. The kidney specialist might also suggest various tests to confirm the diagnosis and assess the severity of the disease, in order to develop a personalised Lupus Nephritistreatment plan. Here are the tests that the patient might undergo for further evaluation and diagnosis of their condition.

Blood and Urine Tests

• Antibody blood tests assess increased levels of proteins made by the immune system.
• Lab tests to evaluate renal function.
• Urinalysis to evaluate the urine for RBCs and other cells
• Urine protein test to determine the presence of protein in the urine.

Kidney Biopsy

A kidney biopsy involves taking a small piece of kidney tissue for examination under a microscope. The biopsy is done in the hospital using ultrasound or CT scan imaging techniques to guide the biopsy needle into the kidney. The area is first numbed to limit the pain, and light sedation may be used during the procedure. A kidney biopsy helps:

• confirm a diagnosis of lupus nephritis
• gives information about disease progression
• guides in formulating a treatment plan

People who are diagnosed with lupus nephritis early and receive prompt treatment have a good prognosis. Those who start taking medications, dialysis, or have a kidney transplant tend to do well. However, most people with lupus nephritis will need to manage their condition with medication or dialysis for the rest of their lives.

Lupus nephritis is a chronic condition with no cure, but treatment can help manage the disease and improve long-term outcomes. The primary goals of lupus nephritis treatment are to:

• reduce or eliminate symptoms, such as blood in the urine, foamy urine, and swelling in the hands, feet, and face.
• prevent disease progression, which can lead to further kidney damage and other complications.
• maintain remission, which is a period of time during which the disease is under control and there are no symptoms.
• avoid the need for dialysis or kidney transplant, which are more invasive and risky treatments.

Usually, doctors recommend the following conservative Lupus Nephritis treatment:

• Diet changes: Limiting the intake of protein and salt in the diet helps improve kidney function.
• Blood pressure medications: Drugs such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) help control blood pressure. They also prevent protein from leaking from the kidneys into the urine. Diuretics can help remove excess fluid from the body.

In case of severe lupus nephritis, drug therapy that suppresses the immune system is typically recommended. The specific medications (steroids/MMF/Cyclophosphamide or others) are used to treat severe lupus nephritis will vary depending on the individual patient's needs and response to treatment. 

Treatment for Kidney Failure

Despite receiving treatment, the decline in kidney function can still advance. When both kidneys become non-functional, individuals with lupus nephritis may require additional interventions for their kidney health.

Kidney Dialysis:Kidney dialysis is a procedure that assists in eliminating excess fluid and waste from the body. It sustains the proper balance of minerals in the bloodstream and regulates blood pressure by filtering the blood through a specialised machine.

Kidney Transplant: In a kidney transplant, a new kidney is surgically implanted from either a living or deceased donor. This procedure offers the opportunity to replace a non-functional kidney with a healthy one, restoring normal kidney function.

What is the outlook for someone with lupus nephritis?

With early diagnosis and treatment, most people with lupus nephritis can live long and healthy lives. Recent advances in treatment have greatly improved the prognosis for this condition. For example, as per The National Center for Biotechnology Information’s report (updated July 2023), the 5-year survival rate is as high as 85% whereas the 10-year survival rate is 73%.

Can lupus nephritis be cured?

There is currently no cure for lupus nephritis. However, treatment can help to manage the disease and prevent further kidney damage. Treatment options include medications, lifestyle changes, dialysis, and kidney transplant.

What are the side effects of lupus nephritis treatment?

The medications used to treat lupus nephritis can have a variety of side effects, ranging from mild to severe. Some of the most common side effects include weight gain, fluid retention, high blood pressure, increased risk of infection, bone loss, and liver damage. It is important to talk to your doctor about the risks and benefits of any medication you are considering.

What is the best treatment for lupus nephritis?

The best treatment for lupus nephritis will vary depending on the severity of the disease and the individual patient's response to treatment. Common treatment options include:

• Hydroxychloroquine: This medication is used to reduce inflammation and suppress the immune system.
• Corticosteroids: These medications are also used to reduce inflammation and suppress the immune system, but they can have more serious side effects than hydroxychloroquine.
• Other immunosuppressants: These medications can be used in combination with corticosteroids or hydroxychloroquine to further suppress the immune system.
• Dialysis: If the kidneys are severely damaged, dialysis may be necessary to filter waste products from the blood.
• Kidney transplant: In some cases, a kidney transplant may be the best option for people with lupus nephritis.

Can you live a normal life with lupus nephritis?

Yes, it is possible to live a normal life with lupus nephritis. With proper management, most people with this condition can enjoy a good quality of life. It is important to work closely with your doctor to develop a treatment plan that is right for you and to monitor your progress over time.

Here are some tips for living with lupus nephritis:

• Eat a healthy diet and exercise regularly.
• Get enough sleep.
• Manage stress.
• Take your medications as prescribed.
• See your doctor regularly for checkups.

Can lupus be cured with surgery?

There is no surgery that can cure lupus nephritis. However, surgery may be used to treat some of the complications of lupus nephritis, such as kidney failure or heart disease.

What is the best treatment for lupus nephritis?

There is no one-size-fits-all answer to this question, as the best treatment for lupus will vary depending on the individual's symptoms and severity of the disease. However, some common treatments for lupus include:

• Medication: Medications such as corticosteroids, immunosuppressants, and biologics can be used to suppress the immune system and reduce inflammation.
• Lifestyle changes: Making healthy lifestyle choices, such as eating a balanced diet, exercising regularly, and getting enough sleep, can also help to manage lupus symptoms and improve overall health.

Is there a permanent treatment for lupus nephritis?

There is no permanent cure for lupus nephritis. However, with early diagnosis and treatment, most people with lupus can live long and healthy lives.

What steroids are used for lupus nephritis?

Corticosteroids are a type of medication that can be used to suppress the immune system and reduce inflammation. They are often used to treat lupus nephritis, especially in cases of severe disease. Some common corticosteroids used for lupus include prednisone and methylprednisolone.

Reviewed by Dr. Yogesh Kumar Chhabra, Principal Consultant – Nephrology, Kidney Transplant on 06-Mar-2024.