Lupus Nephritis

What are the signs and symptoms of lupus nephritis?

Lupus nephritis is typically found during the assessment of patients with other signs and symptoms of systemic lupus erythematosus (SLE). Lupus nephritis can also be the first sign that a person has SLE.

Signs and symptoms of SLE include:

• Weakness and fatigue
• Malaise (a general feeling of discomfort or illness)
• Fever
• Weight loss
• Joint pain
• Muscle pain
• Butterfly rash (a red rash across the cheeks and bridge of the nose)
• Calcinosis (calcium deposits under the skin)
• Vasculitis (damaged blood vessels)
• Alopecia (hair loss)
• Ulcerations (open sores) in the mouth, nose and sometimes the genitals

Lupus nephritis symptoms are the result of kidney dysfunction. Signs and symptoms of lupus nephritis include:

• Blood in the urine
• Abdominal swelling due to built-up fluid
• Low urine output
• High blood pressure

If your child displays these signs and has not yet been diagnosed with SLE, the next step is to order a laboratory evaluation to tell whether SLE is the cause of the kidney dysfunction.

What tests are used to diagnose lupus nephritis?

At Children's Hospital Colorado, your child's initial laboratory evaluation will include blood and urine tests to assess kidney function.

The tests to diagnose systemic lupus erythematosus (SLE) measure specific immune activity, such as the number and type of antibodies (immune proteins) that are associated with SLE. Your child's doctor will also look for abnormalities in other immune substances called complement C3 and C4.

If your child is diagnosed with SLE and symptoms suggest that it is affecting the kidney, your child's doctor will most likely require a kidney biopsy to confirm the lupus nephritis diagnosis.

Why do we do a kidney biopsy for lupus nephritis?

There are several different classifications of lupus nephritis. Results from your child’s kidney biopsy will help doctors determine the class type and choose the best treatment for your child.

Types of lupus nephritis

There are six different classifications of lupus nephritis (called Class I through Class VI), sometimes referred to as lupus nephritis stages.

These lupus classifications are based on the form of abnormal cellular structure caused by gene mutation.

What to expect from a kidney biopsy

At Children's Colorado, we perform a kidney biopsy as an outpatient procedure. We either use sedation to calm your child, or we use full anesthesia which puts them completely to sleep to eliminate stress and pain as much as possible.

To get the tissue sample, we insert a needle through the back onto the surface of the kidney. Using real-time ultrasound to help us guide the needle, we remove a few small pieces of kidney tissue. We then examine the tissue under a microscopic.

After the procedure, which usually lasts about one hour, we will wake your child and monitor them for several hours to ensure any bleeding as a result of the biopsy has ceased. If there are no complications, they may leave the hospital. We recommend they avoid strenuous activities for 7 to 10 days. Once the biopsy results are available a few days after the procedure, we discuss them with you and your child and work with you to develop the best treatment plan.

Why choose us to test for lupus nephritis?

From using smaller needles to fit their smaller veins, to employing distraction methods like virtual reality headsets, all our tests are designed for children. Our child life team helps explain the procedure in a way that your child understands, with the goal of lowering anxiety and making the hospital experience less stressful.

Our nurses, doctors and anesthesiologists have all been specially trained in pediatric medicine, which means they understand how kids are incredibly different from adults. In addition to the vast experience we have caring for children and teens, our pediatric rheumatology team hosts a clinic specifically for children with lupus.

How is lupus nephritis treated?

Lupus nephritis, as well as systemic lupus erythematosus (SLE) in general, are treated with medications that suppress the immune system. These medications usually include steroids and additional drugs we prescribe very precise dosages and manage closely. Specific treatment regimens depend on the class of lupus nephritis found through the biopsy and the overall extent of how the SLE is affecting the body, outside of the kidneys.

Why choose us for lupus nephritis treatment?

As part of our clinic dedicated to lupus nephritis diagnosis and testing, we work with multiple departments within the hospital to provide holistic treatment for your child. We specialize in treating SLE and lupus using a multidisciplinary approach by working with experts in pediatric rheumatology and pediatric nephrology. Our care team combines doctors from both specialties (and more as needed), as well as pediatric nurses, physical therapists, dietitians and pharmacists to ensure your child receives optimal care in a safe and comforting environment.

• Lupus Colorado is Colorado's only nonprofit to serve individuals and families with lupus with the goal of improving the quality of life for all people affected by lupus.
• The Lupus Foundation of America strives to improve the quality of life for all people affected by lupus through programs of research, education, support and advocacy.