Systemic lupus erythematosus — more commonly known as lupus — is an autoimmune disease in which your immune system produces proteins called autoantibodies that attack your own tissues and organs. Some people with lupus develop a form of kidney inflammation called lupus nephritis.

Lupus nephritis occurs when lupus autoantibodies affect the filtering structures (glomeruli) of your kidneys. This abnormal process results in kidney inflammation and may lead to blood in the urine (hematuria), protein in the urine (proteinuria), high blood pressure, impaired kidney function or even kidney failure.

  • Expertise and experience. The large number of kidney specialists (nephrologists) at Mayo Clinic allows doctors to subspecialize in specific aspects of kidney medicine. A number of Mayo Clinic nephrologists specialize in lupus and care for people from all over the world who have the disease, including those with lupus nephritis.
  • Teamwork approach. Lupus can affect almost any part of the body, and people with lupus can have very different symptoms. In Mayo's multidisciplinary practice, your doctor can easily tap into the expertise of other Mayo specialists — including doctors who specialize in kidney disease if you have lupus nephritis. You'll have a treatment plan tailored for your needs to improve your quality of life.
  • New ideas. Mayo researchers conduct studies to better understand lupus and to test novel therapies for lupus nephritis through the Mayo Nephrology Collaborative Group. You may have the opportunity to participate in a clinical trial.
  • Coordinated care. Mayo doctors can work closely with your local doctor to coordinate treatment and follow-up care.

Mayo Clinic in Rochester, Minn., ranks No. 1 for kidney disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., ranks among the Best Hospitals for kidney disorders by U.S. News & World Report. Mayo Clinic in Jacksonville, Fla., is ranked high performing for kidney disorders by U.S. News & World Report.

Your doctor may suspect lupus nephritis if you:

  • Have protein in your urine
  • Have elevated creatinine in your blood
  • Have high blood pressure
  • Show signs of swelling in your hands or feet

Diagnostic tests for lupus nephritis at Mayo Clinic include:

  • Renal function testing. Mayo nephrologists use a variety of tests, including blood tests and 24-hour urine collection, to accurately measure your kidney function. Iothalamate clearance testing, which uses a special contrast agent to track how well your kidneys are filtering, may be done if traditional tests don't provide clear measurement of your kidney function. Mayo Clinic is one of the few centers to specialize in iothalamate clearance testing.
  • Kidney biopsy. Biopsy — where your doctor removes a small portion of kidney tissue for lab analysis — is the gold-standard test to confirm the diagnosis of many kidney diseases, including lupus nephritis. It can also help determine the severity of the disease. Because of the large number of people treated for kidney diseases, Mayo Clinic has a dedicated Renal Pathology Laboratory. Having a biopsy performed at Mayo Clinic ensures that it will be done by specialists with a great deal of experience and an outstanding track record for safety.

Although there is no cure for lupus nephritis, treatment goals aim to:

  • Keep the disease from getting worse
  • Reduce symptoms or make symptoms disappear (remission)
  • Avoid the need for dialysis or a kidney transplant

A treatment plan can help you manage symptoms such as high blood pressure, protein in the urine (proteinuria), and swelling (edema) in the hands and feet.

Conservative treatments

In general, doctors may recommend these treatments for people with kidney disease:

  • Dietary protein and salt restriction. A specialized diet can improve kidney function.
  • Blood pressure medications. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) can help control blood pressure and keep protein from leaking from the kidneys into the urine.

However, conservative treatment alone won't work to treat people with severe forms of lupus nephritis.

Specialized treatments

Specialized treatments used when traditional therapies don't work include:

  • Steroids, cyclophosphamide and immunosuppressants. People with severe lupus nephritis need treatment with immunosuppressive therapies, including drugs such as prednisone, cyclophosphamide, azathioprine (Imuran) and mycophenolate (CellCept). Mayo Clinic experts can help create a treatment plan that maximizes medication benefits and minimizes side effects.
  • Novel therapies. When immunosuppressive therapies don't work to bring on complete remission for people with lupus nephritis, new therapies are needed. Mayo Clinic sometimes tests new drugs and therapeutic strategies for lupus and lupus nephritis in clinical trials offered through the Mayo Nephrology Collaborative Group.

Treatment options for kidney failure

For people who progress to kidney failure, treatment options include:

  • Dialysis. Mayo Clinic offers state-of-the-art dialysis treatment, including the option for in-home dialysis.
  • Kidney transplant. All three Mayo locations offer kidney transplant. Mayo has performed thousands of kidney transplants with better than average results.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

At Mayo Clinic in Arizona, specialists in nephrology and hypertension care for adults who have lupus nephritis.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

At Mayo Clinic in Florida, specialists in nephrology and hypertension care for adults who have lupus nephritis.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

At Mayo Clinic in Minnesota, specialists in nephrology and hypertension care for adults and children with lupus nephritis in the Glomerular Disease/Renal Parenchymal Clinic.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Current therapies aren't always successful in stopping the progression of lupus nephritis. The Mayo Nephrology Collaborative Group includes doctors and researchers who test novel therapies and treatment strategies to increase the success rates of remission.


See a list of publications by Mayo doctors on lupus nephritis on PubMed, a service of the National Library of Medicine.

July 02, 2015