Systemic lupus can affect multiple organs in the body, including the kidneys.

The kidneys are responsible for regulating blood pressure, filtering waste, maintaining fluid balance, and regulating hormone levels. But when lupus nephritis causes inflammation and damage in the kidneys, complications can arise.

This article unpacks everything you need to know about lupus nephritis, including what it is, the symptoms to watch out for, and the options available for managing it.

What is lupus nephritis?

Lupus nephritis, a type of kidney disease, is a common and potentially serious complication of systemic lupus erythematosus (SLE). SLE is the most common type of lupus, an autoimmune condition.

In SLE, the immune system mistakenly targets and attacks healthy cells in the body. The kidneys are one of the organs that can be affected, and the resulting inflammation can impact their ability to work properly.

There are different classes of lupus nephritis:

Class I (Minimal mesangial lupus nephritis): Kidney cells show signs of minimal damage. The kidneys still function as expected.

Class II (Mesangial proliferative lupus nephritis): Mild damage to kidney cells. There are some areas of irritation or swelling, but the kidneys still function well.

Class III (Focal lupus nephritis): Moderate damage to kidney cells, with inflammation and scarring. Kidneys may start to show signs of not working properly.

Class IV (Diffuse lupus nephritis): The most common type of lupus nephritis is caused by severe damage to kidney cells. It may involve significant kidney problems that require treatment.

Class V (Lupus membranous nephropathy): The same as class IV, but protein leaks into the urine. The severity of symptoms varies from person to person.

Class VI (Advanced sclerosing lupus nephritis): End-stage kidney disease, with large amounts of scarring. It is possible for the kidneys to stop working altogether at this stage, leading to kidney failure.

Lupus nephritis is a common complication of living with SLE over time. Up to 5 in 10 adults and up to 8 in 10 children with lupus will develop the condition during their lifetimes.

Symptoms of lupus nephritis

As healthy kidney cells become damaged, they are less able to work properly and can start causing symptoms.

Symptoms of lupus nephritis can go unnoticed at first. When you start noticing symptoms, you may have had the condition for a while.

Common symptoms of lupus nephritis include:

• Swelling (edema) of the lower extremities and face
• Blood in the urine
• Foamy or bubbly urine
• Urinating more often
• Fever with no clear cause
• High blood pressure
• Joint and muscle pain
• Weight gain due to fluid retention

If lupus nephritis isn’t treated or closely managed, it can lead to serious complications over time. These can include heart and blood vessel problems, B-cell lymphoma (a type of cancer), and kidney failure.

This is why early detection and regular monitoring are so important.

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How lupus nephritis is diagnosed

Identifying lupus nephritis early is essential, as treatment can help slow the progression of kidney damage.

Seeing your doctor to discuss your concerns is an essential first step. Coming to that appointment with a clear record of your symptoms and how they have changed over time is the best way to ensure your concerns are taken seriously.

About half of all people diagnosed with lupus nephritis don’t know they have lupus. Because of this, diagnosis can be confusing and overwhelming.

Diagnosis usually begins with blood tests and urine tests to look for signs of lupus activity and kidney involvement. People who already have lupus may undergo these tests regularly to monitor kidney function over time.

If results suggest kidney damage, you may be referred to a specialist for further assessment.

In some cases, a kidney biopsy is needed to confirm nephritis. A doctor retrieves a small tissue sample from your kidney while you are under sedation. The cells are looked at under a microscope to assess the level of damage, which can be used to diagnose and classify your lupus nephritis.

Treatment options for lupus nephritis

Treatment options depend on the stage of lupus nephritis.

Medications

Besides using medications to manage lupus as a whole, some medications can help control kidney damage.

• Hydroxychloroquine, an antimalarial, can relieve lupus symptoms and slow disease progression. Sometimes, this drug takes 1–3 months to have a noticeable effect on symptoms.

• Corticosteroids, often prednisone, can help reduce systemic inflammation. They are commonly used to reduce inflammation in the kidneys.

• Immunosuppressants suppress the immune system’s attacks on healthy cells in the body, including the kidneys.

• Blood pressure medications can be prescribed for people with high blood pressure, a possible complication of lupus nephritis. Examples include ACE inhibitors, dietetics, beta blockers, and calcium channel blockers.

Medications have also been approved to treat lupus nephritis specifically, including obinutazumab (Gazyva).

Dietary changes

Many people with lupus nephritis make dietary changes to support kidney health.

While there’s no single “lupus diet” that works for everyone, consuming a balanced, nutritious diet can help support your overall health. A healthy diet can also help manage lupus nephritis.

• Cutting down on sodium: This can help reduce swelling and high blood pressure caused by lupus nephritis. Ways to reduce your sodium intake include cooking with fresh ingredients, asking for low-sodium options at restaurants, avoiding pre-cooked meals, and looking for low-sodium labels on packaged foods.

• Eating small protein portions: Your kidneys help filter waste produced when the body processes protein. To help make things easier on your kidneys, your doctor may suggest eating smaller portions of protein. You can also explore vegetarian meal options or treat protein as a side dish, not the main focus of every meal.

• Limiting phosphorus and potassium intake: Some people with lupus nephritis can struggle to filter out phosphorus and potassium. Reducing your intake of each can help reduce the burden on your kidneys.

Foods high in phosphorus and their alternatives:

• Cow's milk → rice milk, almond milk, oat milk, or coconut milk
• American cheese → natural cheeses (in moderation)
• Soda → sparkling water
• Deli meat → fresh meat (in small portions)

Foods high in potassium and their alternatives:

• Oranges and bananas → apples and berries
• Fruit juices → sparkling water, tea, or coffee
• Cow's milk → alternative milks like rice milk, almond milk, oat milk, or coconut milk
• Potatoes → rice or cauliflower

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Late-stage lupus nephritis

For most people with class V lupus nephritis or lower, medications and lifestyle changes are enough to manage the condition. But, if kidney damage continues or is caught too late, more invasive options may be required to treat your lupus nephritis. 

• Dialysis: When the kidneys sustain enough damage, they become unable to filter waste out of the blood. If this occurs, dialysis may be needed to carry out that function for them. Hemodialysis is the process of removing blood, filtering it, and then returning it to the body. The procedure is performed multiple times a week, at home or at a healthcare facility. 

• Kidney transplant: Receiving a donor kidney via transplant involves surgically replacing one damaged kidney with a healthy kidney from a donor. This option is often only explored in severe cases of lupus nephritis.

Bring structured data to your lupus appointments

Lupus nephritis can change over time, and symptoms don’t always reflect what’s happening in your kidneys.

Tracking your symptoms alongside medications, diet, and overall health patterns helps you build a clearer picture between appointments. It also shows how your condition responds to treatment over time.

Using the Human Health app, you can log this information in one place and bring structured data into your medical appointments, helping your doctor make more informed decisions about your care.

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Frequently asked questions

What is the prognosis for lupus nephritis

The prognosis of someone with lupus nephritis is generally considered to be good, provided they receive early access to treatment and monitoring. Prolonged periods without treatment or a later-stage diagnosis can result in significant kidney damage, which can change your prognosis and quality of life.

What are the first signs of lupus nephritis?

Early signs of lupus nephritis include foamy urine, weight gain, and swelling in the ankles, lower legs, and face.

Can you prevent lupus nephritis?

There’s no guaranteed way to prevent lupus nephritis if you have SLE. Up to 5 in 10 people with lupus will develop lupus nephritis over time.

However, regular monitoring and consistent treatment can help reduce your risk and detect any changes early.

Diligently tracking your symptoms, following your treatment plan, and talking to your doctor if you notice changes in your health are all essential for managing the condition.

Disclaimer: Human Health is a health tracking platform and does not provide medical advice, diagnosis, or treatment. The information in this guide is for educational purposes only and is not a substitute for professional medical care. Always consult your doctor or healthcare provider with questions about your health.

Sources:

1. What is lupus nephritis? The Lupus Foundation of America
2. Lupus & kidney disease (lupus nephritis), The National Institute of Diabetes and Digestive and Kidney Diseases
3. Lupus nephritis, Cleveland Clinic
4. Lupus Nephritis & Your Kidneys, The National Kidney Foundation
5. Lupus nephritis, Mayo Clinic
6. Lupus nephritis (2025)
7. Medications used to treat lupus, The Lupus Foundation of America
8. Eat healthy when you have lupus nephritis, The Lupus Foundation of America
9. Hemodialysis, The National Institute of Diabetes and Digestive and Kidney Diseases
10. Long-term prognosis of lupus nephritis: comparison between pediatric, adult, and advanced age onset (2025)