Lupus nephritis is a potential cause of chronic kidney disease and affects approximately half of adults with lupus, an autoimmune disease that causes the immune system to attack organs and tissues. Lupus nephritis develops when lupus, also called systemic lupus erythematosus (SLE), damages the kidneys, causing them to stop working as they should. Lupus nephritis can lead to end-stage renal disease and kidney failure, so getting treatment early is essential.

To find a lupus nephritis treatment that works for you, enlist the help of your rheumatologist, a doctor who specializes in immune system and joint diseases, and a nephrologist (kidney specialist). Also, spend some time learning about the disease and your treatment options so you can collaborate with your care team and make informed decisions about your health.

Lupus nephritis is not curable but is treatable. Treatment aims to prevent further kidney damage, reduce symptoms, and slow the progression of the disease to avoid the need for dialysis or a kidney transplant.

Treatment for Lupus Nephritis

Lupus nephritis is not curable but is treatable. Treatment goals include:

• Preventing further kidney damage
• Reducing or easing symptoms
• Slowing or stopping disease progression
• Delaying or eliminating the need for dialysis or a kidney transplant

There are six stages of lupus nephritis, and symptoms and treatment approaches vary by stage. People with more severe lupus nephritis will require more intensive therapy. To determine which stage you have, your health care provider will order blood tests and urine tests to check for kidney damage and evaluate kidney function. They may also perform a kidney biopsy, a test that will accurately determine the stage of your lupus nephritis.

Lupus nephritis treatment usually involves suppressing the immune system to limit damage to the kidney. Your doctor may combine medications to increase their effectiveness or prescribe them in a specific order to avoid harmful side effects. It’s important to stick with your treatment plan and work with your care team. If you have side effects, tell your doctors right away. If they schedule a follow-up appointment, make it a priority. If you have questions, ask.

"Lupus nephritis treatment usually involves suppressing the immune system to limit damage to the kidney.

Check out five types of treatment that can help you manage lupus nephritis.

1. Immunosuppressants

In people with lupus nephritis, inflammation caused by the immune system damages the kidneys. To prevent or slow kidney damage, your doctor may recommend immunosuppressants, which are medicines that reduce inflammation and calm down an overactive immune system.

Several types of immunosuppressants can treat lupus nephritis, including corticosteroids, chemotherapy drugs, calcineurin inhibitors, and biologics. In some cases, the American College of Rheumatology recommends combining two or more immunosuppressants, depending on disease activity and stage. Ask your health care provider what treatment approach they recommend and why.

Immunosuppressants, including corticosteroids, chemotherapy drugs, and biologics, help limit kidney damage in lupus nephritis by reducing inflammation and immune system overactivity.

Immunosuppressive drugs affect the immune system’s ability to fight off infection. If your doctor prescribes immunosuppressants for lupus nephritis, protect yourself by avoiding people who are sick or have an active infection.

Corticosteroids

Corticosteroids are sometimes called glucocorticoids or steroids. These artificial hormones are similar to the hormone cortisol, which the body produces naturally. Steroids help by lowering the amount of molecules that cause inflammation and calming down immune system cells. Some commonly used steroids include prednisone (Rayos), cortisone, and methylprednisolone (Medrol). These drugs can be taken orally (by mouth) or through injection.

Although steroids can reduce inflammation and immune system activity, they can also cause side effects, including high blood pressure, high blood sugar, weight gain, and osteoporosis (weakening of the bones). To prevent harmful side effects, your doctor might limit how long you take steroids.

Chemotherapy Drugs

Some chemotherapy drugs can be used as immunosuppressants to treat lupus nephritis. Chemotherapy drugs prevent the growth and division of cells, including the cells in the immune system that divide when activated. This activation and cell division occurs during autoimmune disease and can lead to an attack on the body’s tissues, including the kidneys. Some common examples of chemotherapy drugs used to treat lupus nephritis include cyclophosphamide and mycophenolate mofetil (CellCept, Myfortic, Myhibbin).

Each type of chemotherapy drug will have side effects such as nausea, upset stomach, and fatigue. The journal Biochemistry Research International explains that cyclophosphamide is very effective for lupus nephritis. However, it should be used with caution in younger patients because it can affect fertility in both men and women.

Calcineurin Inhibitors

Calcineurin inhibitors stop or slow down the action of calcineurin, an enzyme, which is a protein that helps chemical reactions occur in the body. Inhibiting calcineurin can prevent immune cells from attacking the body’s own tissues. Common calcineurin inhibitors used for the treatment of lupus nephritis include voclosporin (Lupkynis), cyclosporine (Gengraf, Neoral, and Sandimmune), and tacrolimus (Astagraf, Envarsus, Prograf).

Calcineurin inhibitors must be used carefully during the treatment of lupus nephritis, as they can harm the kidneys and liver. High blood pressure is another side effect associated with these medications.

Biologics

Biologic treatments are made from living cells. They bind to inflammatory molecules and cell types associated with lupus nephritis. Biologics are given by injection instead of by mouth to prevent the digestive system from breaking them down or not absorbing them. After being injected into the body, the biologic destroys or blocks its target.

Belimumab (Benlysta) was the first biologic approved by the U.S. Food and Drug Administration (FDA) to treat lupus nephritis.

Common side effects of biologic therapies include:

• Injection site reaction
• Joint pain
• Muscle soreness
• Sore throat
• Fatigue
• Headaches
• Severe allergic reaction (in rare cases)
• Infections
• Mental health problems

2. Blood Pressure Medications

The kidneys help regulate blood pressure. Kidney damage from lupus nephritis and medications such as oral steroids can cause high blood pressure. Because this can further damage the kidneys, controlling high blood pressure is very important during the treatment of lupus nephritis. Keeping blood pressure under control can also help reduce proteinuria, a condition that causes excess protein to leak into the urine, leading to foamy urine.

The kidneys remove excess fluid, but lupus nephritis can damage them and interfere with this process. Diuretics help by removing fluid as well.

Common blood pressure medications used to treat the symptoms of lupus nephritis include ACE inhibitors and angiotensin-receptor blockers as they help control blood pressure and also reduce proteinuria.

Other medications that help with controlling blood pressure are diuretics. The kidneys remove excess fluid, but lupus nephritis can damage them and interfere with this process. Diuretics are medications that remove fluid from the body. Commonly used diuretics for the treatment of lupus nephritis include furosemide (Lasix, Furoscix) and hydrochlorothiazide (abbreviated as HCTZ).

3. Dialysis

People diagnosed with stage 6 lupus nephritis usually need more intensive therapy. This stage of lupus nephritis is diagnosed when 90 percent or more of the kidney has been damaged, and kidney function is very poor. Stage 6 lupus nephritis treatment helps do the job your kidneys can’t do anymore. One treatment option for this stage is dialysis.

Dialysis is a medical procedure that removes waste and certain chemicals from the blood. Healthy kidneys can do this for the body, but once a person loses kidney function, they must rely on dialysis to clean the blood.

There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, blood is drawn from your body, filtered through a machine to remove waste and excess fluid, and then returned to your body. In peritoneal dialysis, a fluid called dialysate is placed into your abdomen through a catheter, where it absorbs waste and excess fluids before being drained and replaced. Both methods help manage kidney failure, with the choice depending on your medical needs and lifestyle.

Dialysis also ensures the levels of potassium, bicarbonate, and sodium in the blood are balanced. This procedure can also help control blood pressure.

Dialysis must be performed often and can be time-consuming. For example, hemodialysis can take up to four hours and is usually done three times per week.

4. Kidney Transplant

An alternative to dialysis is a kidney transplant, which can restore kidney function. Getting a transplant requires:

• Working with a transplant center
• Undergoing a medical evaluation to determine if a transplant is the right approach
• Matching with a kidney donor

Finding a donor can be challenging because the donor and recipient must have certain matching characteristics to make it more likely that the transplant will succeed. After the transplant operation, you will have to take antirejection medications to prevent your body from attacking the new kidney. Lupus nephritis can develop in the transplanted kidney, and some people end up needing a second kidney transplant.

Living a healthy lifestyle can support kidney health and help manage lupus nephritis.

Lifestyle Habits To Support Kidney Health

Living a healthy lifestyle can support kidney health and help manage lupus nephritis, so you can try to prevent severe lupus nephritis or kidney failure. Habits that support overall and kidney health include:

• Regular exercise
• A low-sodium diet (less than 2,300 milligrams per day)
• A low-cholesterol diet
• Maintaining a normal body weight
• Adequate hydration
• Limited alcoholic drinks
• Not smoking
• Keeping your blood pressure in the normal range

If you have active lupus nephritis, see a nephrologist along with your rheumatologist and other health care providers. Together, you and your care team can create a treatment plan to help manage the condition and find what works for you.

Connect With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 233,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus and lupus nephritis.

Are you living with lupus nephritis? Which treatments have worked for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.