Lupica Nephropathy: Symptoms, Diagnosis and Treatment

It is the term used to refer to renal involvement disseminated lupus erythematosus, which occurs in a significant percentage of patients.

This percentage can vary between 30 and 80%, depending on how it is presented and the age of onset.

The nephrologists give importance, and it arises from being a severe but treatable disease. It is one of the few cases in which the performance of the renal biopsy is obligatory since the conclusions result in significant changes in the treatment.

Risk factors of this Kidney Disease

The exact etiology of lupus remains unclear. We know that it is an autoimmune disease that manifests itself because there is no production of antibodies against various self-antigens that lead to tissue destruction, which means that the immune system does not protect the body since it does not differentiate between good or dangerous substances. It is unknown why it occurs in some people and not in others. There may be a connection with some past or present infection, and there may be a family association, although the responsible gene has never been found.

There are also associated medications such as (procainamide and hydralazine), which can sometimes precipitate similar syndromes. It is believed that the factors that lead to kidney injury are the same, although, again, it is not known what is different in those who have lupus nephritis. However, the incidence is higher in women, blacks, adolescents, and young adults of oriental descent.

Signs and symptoms

Renal manifestations of lupus nephritis range from asymptomatic urinary abnormalities, proteinuria, and nephrotic syndrome, subjected to varying degrees of renal failure. It can lead to irreversible kidney failure that needs to be replaced with a chronic kidney condition treatment. Hypertension is more severe in patients with more severe nephritis.


In addition to kidney function tests and urinalysis, renal biopsy is the method of choice to establish the form of renal involvement and, consequently, the patient’s prognosis. It is, therefore, a situation in which the biopsy is indicated. Thus, the WHO has a classification based on optical microscopy that, in its 2003 revision, divided patients into six classes:


• Class I (minimal injuries), present in less than 5% of patients;

• Class II (pure mesangial), present in 10 to 25%;

• Class III (focal and segmental proliferation) in 20 to 35%;

• Class IV (diffuse proliferation) in 35 to 60%;

• Class V (membranous), 10 to 15%;

• Class VI (diffuse sclerosis) corresponds to irreversible chronic renal failure in 8 to 15% of patients.

The treatments and forecasts

The prognosis of lupus nephritis is analyzed with one variable more than the overall prognosis: there is a loss of the kidney, and there is no loss of life. The clinical course has improved with better use of immunosuppressive drugs. Currently, in most patients, there is an excellent initial response; after a period of inactivity, outbreaks of deterioration may arise. Other times, impairments appear when reducing the doses of immunosuppressants below a certain level. These different behaviors depending on the duration and intensity of immunosuppression rather than the severity of the disease.

The treatment has two phases: induction and maintenance. The concern of the first phase in the treatment of the disease that is potentially fatal; The second objective is to prevent relapse with caution to control the appearance of side effects of immunosuppressive drugs.

All forms of lupus nephritis at some point in its evolution are medicated. It is unknown if the milder forms benefit from these medications since test studies have never been done. The most controversial clauses in this sense are II and V. Independently of the treatment with corticosteroids, and it is necessary to resolve some other spontaneous way of evolving to advanced renal failure. The most serious (Class III and IV) are those in which the usefulness of the treatment is demonstrated.

The standard treatment is corticosteroids. The usual start is to induce it with an intravenous bolus (500 mg to 1 g) of methylprednisolone, and prednisolone, followed by 60 mg/kg orally. Later, after resolving the acute crisis, the slow decline begins at the level where there are no symptoms. There are other immunosuppressive drugs indicated for lupus. Cyclophosphamide is the most studied because its main side effects include leucopenia and the consequent risk of infection. Therefore, they are not schemes that reduce the dose and its side effects. Other studied medications are also; azathioprine, mycophenolate mofetil, cyclosporine, and chlorambucil, but none of them won their place.