Symptoms of lupus nephritis
How does a patient with lupus nephritis present clinically?
Although kidney involvement may be the first sign of SLE in an individual patient, lupus nephritis typically becomes clinically apparent as a manifestation of the systemic disease.
In the Systemic Lupus International Collaborating Clinics classification criteria, patients with biopsy-proven lupus nephritis in the presence of antinuclear antibodies (ANA) or antibodies to double-stranded DNA (anti-dsDNA) satisfy criteria for a diagnosis of SLE.
Some patients with lupus nephritis are asymptomatic, but classically patients will have a variety of systemic manifestations including but not limited to the following:
- • Cutaneous abnormalities
- • Fever
- • Malaise
- • Weight loss
- • Synovitis
- • Raynaud phenomenon
- • Serositis
- • Pericarditis
- • Retinopathy
- • Thrombotic microangiopathy (TMA)
- • Neuropsychiatric involvement
- • Hematologic abnormalities
- • Leukopenia
- • Anemia
- • Thrombocytopenia
Evidence of immunologic activity in the serum is usually present as ANA, anti-dsDNA and Smith (anti-Sm), and hypocomplementemia (see Serologic Evaluation, further on). The pattern of clinical activity varies between patients but characteristically is one of relapsing and remitting disease.
Only 10% of patients with discoid lupus will develop SLE; if so, they seldom develop nephritis. Certain medications, such as hydralazine or procainamide, may cause drug-induced systemic lupus, but they are only rarely associated with lupus nephritis.
In patients with kidney involvement, presentation can range from subtle disease such as asymptomatic microscopic hematuria and proteinuria on urinalysis with normal kidney function to nephritic and/or nephrotic syndrome and rapidly progressive glomerulonephritis with kidney failure and hypertension. Nephrotic syndrome is present in approximately 25% of patients during their disease course.
Microscopic hematuria is commonly associated with proteinuria and rarely found in isolation. Kidney failure, defined by an elevated serum creatinine, is present in approximately 40% of patients with lupus nephritis.
