Lupus nephritis is a kidney disease caused by lupus. As we know, lupus itself is an autoimmune condition, where it occurs when the immune system attacks healthy cells, organs, and tissues, and the cause is unknown. In this autoimmune condition, the organ affected is the kidneys, which can cause inflammation or kidney damage.

Symptoms

Symptoms may develop during or immediately after common lupus symptoms appear, such as joint or muscle stiffness, fever, fatigue, skin rash, mouth or nose sores, and sensitivity to light. Furthermore, symptoms related to the kidneys will appear similar to other kidney diseases, such as:

• Dark, foamy, or bloody urine

• Increased frequency of urination

• High blood pressure

• Swelling in the legs, ankles, and feet

• Weight gain

One of the symptoms of lupus nephritis is swelling in the legs, ankles, or feet.

Classification

As mentioned, symptoms may not immediately appear, but a diagnosis must be obtained promptly to prevent more severe kidney damage. There are 6 stages of lupus nephritis based on the modified WHO classification by the International Society of Nephrology and the Renal Pathology Society, namely:

• Class 1: Minimal mesangial lupus nephritis

• Class 2: Mesangial proliferative lupus nephritis

• Class 3: Focal lupus nephritis (active and chronic, proliferative and sclerosing)

• Class 4: Diffuse lupus nephritis (active and chronic, proliferative and sclerosing, segmental and global)

• Class 5: Membranous lupus nephritis

• Class 6: Advanced sclerosis lupus nephritis

Diagnosis

Examinations needed to diagnose lupus nephritis include physical examination for edema (to see if there is fluid accumulation in the body), blood tests (to measure kidney function by looking at creatinine and urea levels), 24-hour urine collection (to measure the kidney's ability to selectively filter waste), and urine tests (to measure kidney function through levels of protein, red blood cells, and white blood cells).

When the suspicion of the disease is stronger, then it may be recommended to undergo a kidney biopsy, by inserting a needle through the abdomen and kidney to take a tissue sample. This method is considered the gold standard method because the results are used as the basis for treatment planning.

The initial step in testing for lupus nephritis is a blood test to see creatinine and urea levels.

Treatment

The goal of treatment is to help reduce kidney inflammation, stop the immune system from attacking the kidneys, and provide relief for symptoms. Treatment is tailored to its class level, for example, classes 1 and 2 require monitoring, class 3 is assisted with immunosuppressants, up to class 6 with kidney transplantation.

Some treatment strategies are as follows:

• Adapting to a new diet by limiting protein and salt intake

• Taking ACE inhibitors to address high blood pressure

• Taking diuretics to reduce swelling

• Taking corticosteroids to reduce inflammation

• Taking cyclophosphamide to suppress the immune system

• Regular hemodialysis when kidney damage is severe

• Transplantation as a final additional treatment option

Prognosis

Lupus nephritis cannot be cured and it is a severe form of lupus complication. However, over time, someone's chances of living normally increase. Diagnosis and treatment need to be obtained as soon as possible so that symptoms can be managed well, allowing normal activities like other healthy individuals.

So, lupus nephritis occurs when the immune system attacks the kidneys. The cause is unknown, and the symptoms will be similar to what happens in lupus and other kidney diseases. Treatment is also similar to a kidney failure approach, such as dietary changes, medication consumption, up to hemodialysis if severe.

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