Chronic inflammation of the kidney may indicate the possibility of an autoimmune disorder, in which the body's defense mechanism attacks its own cells and tissue ‘by mistake'. Systemic Lupus Erythematous, abbreviated as SLE, is one of the several autoimmune disorders that affect thousands of people across the world. SLE can attack the major organs and circulatory systems in the body including kidneys, lungs, hematopoietic system, and Central Nervous System at large. However, SLE when it affects the kidneys and causes chronic inflammation, it is an indicative condition of lupus nephritis. Nephrons are the functional units of the kidneys and damage to it may cause partial or complete kidney failure in extreme cases, and might also require kidney transplantation.

a. What is lupus nephritis?

When SLE affects the kidneys, the condition is known as Lupus Nephritis. Scientific and biological causes for the condition may vary from person to person. However, the most common cause being immunoglobulin deposition, which primarily activates cell inflammation.

Based on the causes and effects, lupus nephritis has been categorized under several stages, which are:

Class I: Minimal or nominal lupus nephritis affecting the specialized cells (mesangial cells) of the glomerulus.

Class II: Proliferative LN of the mesangial cells of the glomerulus.

Class III: Focal LN. This stage indicates active lupus nephritis and is mostly chronic. It is also sclerosis and proliferative stage. CD8+ T Cells extensively cause inflammation.

Class IV: Diffusive LN. In addition to the criteria of Class IV, this stage also represents segmental characteristics. CD8+ T cells extensively cause inflammation.

Class V: Membranous LN

Class VI: Sclerosis LN in the advanced stage

b. Symptoms of Lupus nephritis

Symptoms of lupus nephritis are quite similar to other clinical disorders which may lead to kidney damage. This is because the accumulation of proteinaceous compounds in the kidney leads to faulty excretion of nitrogenous wastes in the body. Hence, the primary symptoms of the condition are:

● Frothy urine. Presence of excess froth in the urine gives a clear indication of excessive proteins.

● Presence of blood along with urine. In some cases, the candidate fails to recognize the presence of blood in the initial stages, however, confirmatory blood tests for RBC in urine may suggest otherwise.

● Laboratory tests confirming the presence of creatinine (nitrogenous waste) in the urine

● Fluid accumulation in hands and feet leading to visible swelling and pain. Renal damage from lupus nephritis reduces the functioning capability of the kidneys, and thus, inadequate filtration of bodily fluids. This directly leads to insufficient albumin production causing exaggerated leaking of fluid and thereby swelling.

● Elevated blood pressure

● The sudden increase in body weight

c. Diagnosis for Lupus

Diagnosis to determine or confirm the suspected symptoms of lupus nephritis may vary depending on the type and stage of the disease. Preliminary tests may include:

● Laboratory tests: Tests to determine the presence of Red Blood Cells, creatinine, and proteinaceous substances are primarily preferred.

● Ultrasound: Ultrasound of the kidneys, helps in determining the extent of renal inflammation, and helps in determining the abnormality in the size of kidneys, as well as echogenicity of the cortical region.

● Kidney Biopsy: Highly needed to determine the stage of lupus nephritis, kidney biopsy helps in determining the active urine sediment, which gives a detailed analysis of the presence of cell casts/ mass, as well as hematuria. Besides, the biopsy also suggests the presence of proteinuria and helps in determining other abnormalities in the renal functioning.

d. Treatment/Surgery for Lupus nephritis

There is a total of five different types of lupus nephritis which affect people at large. The diagnosis and the treatments vary a great extent, depending on the type, extent, and stage of LN that affects the candidates. Hence, here are some of the general treatments suggested to candidates suffering from lupus nephritis:

● Medication:

 - Immunosuppressive drugs: Since lupus is a type of autoimmune disorder, the primary medication prescribed in this case is immunosuppressive drugs, in order to suppress the body’s elevated defense mechanism acting against its own cells and tissues. Drugs like azathioprine, mycophenolate, cyclophosphamide, etc., are mostly prescribed in this condition.

 - Corticosteroids to combat chronic inflammation. Reducing inflammation is one of the primary treatments in the case of lupus nephritis, for which a controlled dosage of corticosteroids is highly preferred.

 - Blood thinners, vasodilators and medication for blocking Angiotensin II receptors might also be prescribed to patients showing high BP and signs of blood clotting.

● Dialysis:

Dialysis or artificial filtration of the blood outside the body is highly useful in such cases. This is because damage to the kidney results in faulty blood filtration thereby leading to the accumulation of harmful nitrogenous wastes. In this case, the candidate has to undergo periodic dialysis for cleansing of the blood artificially.

● Kidney transplantation:

Kidney transplantation for lupus nephritis is preferred in case of unrecoverable or complete damage to the kidney. Transplantation of the damaged kidney with a healthy one helps in extending the lifespan of the candidate providing him a better chance at survival.