Lupus Nephritis

Lupus nephritis is clinically evident in 50-60% of patients with systemic lupus erythematosus (SLE), and it is histologically evident in most SLE patients, even those without clinical manifestations of renal disease. (See the image below.) Evaluating renal function in SLE patients is important because early detection and treatment of renal involvement can significantly improve renal outcome.

Signs and symptoms

Patients with lupus nephritis may report other symptoms of active SLE (eg, fatigue, fever, rash, arthritis, serositis, or central nervous system [CNS] disease); these are more common with focal proliferative and diffuse proliferative lupus nephritis.

Asymptomatic lupus nephritis

During regular follow-up, laboratory abnormalities suggesting active lupus nephritis include hematuria or proteinuria; this is more typical of mesangial or membranous lupus nephritis.

Active nephritis

Nephritic symptoms related to hypertension and poor renal function (typical of diffuse lupus nephritis):

  • Peripheral edema
  • Headache and dizziness
  • Nausea and vomiting

Nephrotic symptoms related to proteinuria typical of membranous lupus nephritis):

  • Peripheral or periorbital edema
  • Coagulopathy

Physical findings

  • Focal and diffuse lupus nephritis – Generalized active SLE with the presence of a rash, oral or nasal ulcers, synovitis, or serositis; signs of active nephritis
  • Active lupus nephritis – Hypertension, peripheral edema, and, occasionally, cardiac decompensation
  • Membranous lupus nephritis – Peripheral edema, ascites, and pleural and pericardial effusions without hypertension