Lupus affects different people in different ways. Many people with lupus have problems with their kidneys.

How does lupus affect the kidneys? 

Your kidneys filter waste and extra water out of your blood to make urine (pee). They also help control your blood pressure and keep the right balance of salts, acids, and minerals in your blood. 

Lupus can cause a kidney disease called lupus nephritis. Lupus nephritis is inflammation in the kidneys that can make them stop working. When the kidneys aren’t working well, waste builds up in the blood and extra water builds up in the body. 

Lupus nephritis is most common in people ages 20 to 40. It usually starts within 5 years of your first lupus symptoms.

What are the symptoms of lupus nephritis?

In the early stages of lupus nephritis, you might not notice any symptoms. As the disease gets worse, it can cause the following symptoms:

• Swelling (usually in the feet, ankles, legs, or face)
• Foamy urine
• Peeing more often than usual, especially at night
• High blood pressure

Pregnancy can cause some of the same symptoms, like swollen feet and ankles. If you have any of these symptoms during pregnancy, tell your doctor. You may need tests to find out if your symptoms are caused by pregnancy or by a kidney problem.

Learn more about lupus and pregnancy.

Other problems in the urinary system

In addition to lupus nephritis, lupus and lupus treatments can increase your risk for other problems in the urinary system (the system that makes pee):

• Urinary tract infections (UTIs) 
• Lupus cystitis (inflammation in the lining of the bladder) 

The most common symptom of UTIs and lupus cystitis is peeing more often than usual. Your doctor can do tests to find out whether problems in your urinary system are caused by lupus or by a medicine you’re taking to treat lupus.

Take steps to protect your kidneys

Making healthy food and beverage choices can help protect your kidneys and manage the symptoms of lupus nephritis and other kidney problems. 

Try these steps:

• Eat less sodium (salt) to help control your blood pressure and reduce swelling
• Eat smaller portions of foods with a lot of protein, like meat and dairy
• Cut back on foods with saturated fats, like butter and fatty meats
• If you drink alcohol, drink only in moderation
• Work with your doctor to control your blood pressure, diabetes or high cholesterol

If you have severe kidney problems, you may also need to limit the amount of fluid you drink or the amount of certain minerals in the foods you eat. Work with your doctors to make a plan that’s right for you.

Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can cause kidney damage. If you have kidney problems, talk with your doctor about ways to treat your lupus-related inflammation without using NSAIDs.

Find out if you have lupus nephritis

Since lupus nephritis may not cause symptoms at first, it’s important that people with lupus get tested for kidney problems. Your doctor or a special doctor called a nephrologist can find out if you have lupus nephritis or other problems in your urinary system. 

You may need different kinds of tests, including: 

• Urine tests to check for blood and protein in your urine
• Blood tests to check how well your kidneys are filtering waste out of your blood
• Kidney biopsy to check for inflammation and scarring in your kidney tissue

Find the right treatment plan

Kidney problems can be serious, and it may take months to find the right combination of medicines to treat them. Your doctor or nephrologist can help you find a treatment plan that works for you.

Medicines to treat lupus nephritis include:

• Lupkynis (voclosporin)
• Benlysta
• Steroids, like prednisone
• Immunosuppressives, like mycophenolate mofetil (CellCept®)

Your treatment plan may also include medicines or other ways to control your high blood pressure, diabetes or high cholesterol.

Learn more about lupus medicines.

If your kidney problems cause kidney failure, you’ll need a treatment called dialysis. Dialysis uses a machine to filter waste and extra water out of the blood. You may also need a kidney transplant to replace your kidneys. 

Learn more about kidney transplants. 

If you have lupus nephritis, remember that you’re not alone. Read these stories about people with lupus nephritis and their diagnosis and treatment journeys.