Diagnosis

Lupus Nephritis: 6 Classes of Kidney Disease

Caused by systemic lupus erythematosus, lupus nephritis is a serious, and relatively common, kidney disorder.

In September, Selena Gomez shared with her fans via Instagram that she had received a kidney transplant due to complications of lupus. The two kidneys are the primary members of the renal system in the body and are crucial in ensuring that:

waste and toxic substances are removed;
hormones controlling blood pressure and volume are regulated; and
the proper levels of fluids exist throughout the body

Lupus nephritis is a common condition, impacting nearly 40% of people with lupus, according to the Lupus Foundation of America. However, the symptoms of kidney disorders are are often subtle and easy to miss. Because of this, it is important to know the symptoms of lupus nephritis and to speak with your lupus treatment team if you are experiencing any symptoms.

Know the symptoms of lupus nephritis? Learn More

Lupus nephritis – Advanced definition

Lupus nephritis is a specific type of inflammation in the kidneys known as a glomerulonephritis. In this type of disease, the glomeruli are inflamed.

The glomerulus is a network of tiny tubes that transport blood, known as capillaries. It is found at the beginning of the nephron in the kidney.

Because of some specific blood circulation patterns in this part of the body, there is a lot of hydrostatic pressure in the glomerulus. This pressure is used for ultrafiltration, a process that removes large proteins from the blood cells so that it can be removed from the body in urine.

As part of this process, the glomerus is filled with mesangial cells. These cells make up 30-40% of the cells in the glomerulus. Mesangial cells work to keep this filtering mechanism clean and clear of excess proteins or other residue.

Many tools can be used to diagnose lupus nephritis including blood tests, urinalysis, x-rays, and ultrasounds. Kidney biopsies are also a crucial part of the diagnostic and classification process, even though they are invasive.

Because kidney biopsies are invasive, recent analysis has examined their role. A 2016 article published in Reumatologia explored the question and concluded that: “In daily practice initial and repeat renal biopsies remain an important and valuable tool.” This sentiment was echoed in a 2012 journal article in the Clinical Journal of the American Society of Nephrology.

Lupus nephritis – WHO Classifications

The World Health Organization has subdivided lupus nephritis into 6 stages. The classes represent different severities and require different treatment options. These classes are identified by a clinician examining the kidney biopsy with specialized microscopes and immunofluorescence.

NOTE: Always work with your doctor and/or lupus treatment team to identify the best treatment plan.

Class 1

Known as: Minimal mesangial glomerulonephritis

Prevalence: Seen in 10-25% of people with lupus (SLE). 5% of lupus nephritis cases are class 1.

Diagnosed: Immune complex (antigen-antibody complex) deposits are specific molecules that can result from SLE. They build up in trace amounts in the glomerulus in class 1 lupus nephritis. This build-up can be seen under an electron microscope. Urinalysis is normal.

Class 2

Known as: Mesangial proliferative glomerulonephritis

Prevalence: 20% of lupus nephritis cases are class 2

Diagnosed: If there is any masangial hypercellularity (excessive messangial cells in a small defined area) related to immune complex deposits.

Treatment: Typically responds to corticosteroids. Kidney failure is rare.

Class 3

Known as: Focal glomerulonephritis

Prevalence: 25% of lupus nephritis cases are class 3

Diagnosed: Active lesions exists in less than half of the glomeruli. Usually, lesions occur in one or two focused locations. A person may exhibit microscopic amounts of blood in the urine (hematuria) and/or excess protein in the urine (proteinuria).

Treatment: Typically responds to high doses of corticosteroids. Kidney failure is uncommon.

Class 4

Known as: Diffuse proliferative nephritis

Prevalence: 40% of lupus nephritis cases are class 4. Very severe subtype.

Diagnosed: More than 50% of the glomeruli are affected with active lesions. Immune complex deposits exist under the endothelial when viewed with an electron microscope. People will experience hematuria and proteinuria. Often, there will be hypertension, elevated serum creatinine, and raises anti-dsDNA titres.

Treatment: Treated with corticosteroids and immunosuppressant drugs. Kidney failure is common in class 4.

Class 5

Known as: Membranous glomerulonephirits

Prevalence: 10% of lupus nephritis cases are class 5.

Diagnosed: Extreme swelling (edema) and proteinuria. The glomerular capillary wall is thicker in segments, or entirely. May experience renal vein thromboses, a pulmonary embolism, or other thrombotic complications. Active lesions are present.

Treatment: Treated with corticosteroids and immunosuppressant drugs. Kidney failure is uncommon.

Class 6

Known as: Advanced sclerotic

Diagnosed: Global sclerosis – typically more than 90% of the glomeruli are involved and have active lesions. Class 6 is characterized by progressively worse kidney function.

Being aware

Kidney disease often presents without obvious symptoms. Because of this, it is important to be on the lookout for the following symptoms:

foamy urine
blood in the urine
dark urine
changes in the frequency of urination
water retention or weight gain throughout the body, including the legs and hands

And, always bring up your concerns with your lupus treatment team.

Comments (24)

24 thoughts on “Lupus Nephritis: 6 Classes of Kidney Disease”

Jim Epps says:

August 24, 2019 at 3:18 am

I’m currently hospitalized for renal and pulmonary complications high ANA labs two years straight, inconclusive diagnosis on specific condition with active symptoms need direction

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1. brett says:
  
  August 29, 2019 at 2:44 pm
  
  Hi Jim,
  Sorry to hear it! Here is a LupusCorner article on some of the pulmonary conditions that have been linked to lupus or are common complications. The diagnosis process for lupus and other autoimmune conditions is unfortunately quite difficult. Best wishes!
  -Brett
  
  Reply
2. Mary Gutierrez says:
  
  April 12, 2020 at 5:25 pm
  
  Has anyone with SLE nephritis tried cbd to control symptoms.
  
  Reply
  1. Tee-Rex says:
    
    May 9, 2021 at 1:18 am
    
    Yes/ 10yr Lupus/ I just started using Natural treatments/ Marujaua(any form)cbd for sure/ sea moss (keep it simple w/capsules / B12/CBD oil/ waaaaay better results / nnnnnoooo more pharm meds 4me/ VitC/ ALL pain doesn’t clear but definitely treating EACH symptom one@a time/ STEROIDS ARE KNOWN FOR DEMENTIA GUYS/// don’t be afraid to switch up BUT according to what’s BEST 4YOU…. CAN’T DIE TRYING diff things/ depression TOUGH TOO BUT HEY remembering RIGHT AWAY that YOU THINK YOU’RE DEPRESSED BUT YOU’RE REALLY NOT…. 😧🥺😬😁😁😁😊
    
    Reply
Amber says:

September 12, 2019 at 9:21 pm

I was diagnosed with arthritis in the ER because of positive ANA when I was 16. I’m 23 now and I’m falling apart. I have to urinate every 5 minutes and everyone keeps saying it’s diabetes. I just got an mri back which was specifically for my spine but more than that popped up kidney cysts popped up. Do I have lupus, how do I get my doctor to listen?

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1. Marietta Walker says:
  
  May 11, 2020 at 4:45 am
  
  You need to go to a Rheumatologist and have ANA test again. Your doctor can take these test also, so you might just ask him to run A good Rheumy, which sometimes takes a while to find, will test your blood in many different ways. Peeing that often is dangerous. Please keep hydrated and get to a doctor. Is anyone watching you glucose and checking you for diabetes. Do you have a regular doctor? If not, you need to find one. Or do you KNOW you do have Diabetes?
  
  Reply
  1. Jessica says:
    
    November 6, 2020 at 4:50 am
    
    You may want to go to a nephrologist and confirm that you do not have PKD, Polycystic Kidney Disease. It can be very serious, depending on how quickly the cysts grow and type one has. It is a directly heritable disease. My mom just had a kidney transplant as a result of the disease. I have SLE, but did not inherit PKD, though both my sister and my niece did. Whenever I hear about cysts instead of lesions or scarring, I think of PKD not lupus.
    
    Reply
lureather says:

February 1, 2020 at 11:25 pm

hi i had surgery on 29th of november 2019, why am i still having complication , like it feel like water movement .. i was given antibiotics for phnemonia and inflammation on my kidneys but it still feels funny but my pain did stop.. it just feels like in my kidney area some fluid is moving..

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Joyce Tivis says:

February 27, 2020 at 6:25 am

Was diagnosed over 15 years ago, 4 years ago was hospitalized for 2months with bacterial meningitis in January 2020 had heart surgery, but with all of this and more, I think I’ll kick lupus butt. Once I realized I’ll be In some sort of discomfort for the rest of my life only made it easier.

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Michelle Argueta says:

July 1, 2020 at 7:12 pm

I am 27 years old and I was taken to the hospital for my rapid spreading vasculitis and dark deep leg ulcers. I have had ANA profiles done which confirmed that I have class 4 lupus. Treatment is to be on prednisone and celcept for up to 2-4 months. I was explained the complications that come with taking both drugs such as osteoporosis, weight gain and eye sight issues. I was also warned against getting pregnant as that could severely affect me and my baby. What can I do while taking the drugs to not affect my possibility of getting pregnant in the future?

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1. Melissa Blankenship says:
  
  January 6, 2021 at 7:06 am
  
  I have been on hydroxychloroquin for 4 years now. I carried my baby just fine. I had to do 2 blood thinner shots a day for 7 months and a lot of extra ultrasounds and appointments. I would discuss this possibility with your doctor.
  
  Reply
  1. Brenda Greer says:
    
    April 12, 2021 at 3:20 am
    
    I was on Hydrochloroquin for 18 years. I developed crystals in my eyes. I can no longer use it for my joint pains. I’m hurting so bad now. Make sure you have regular eyes check ups. It’s not reversible.
    
    Reply
Katherine D Sanberg says:

July 9, 2020 at 12:47 am

I was diagnosed with Lupus two years ago. Since then I have this pain ony right kidney that feels like I’m passing a kidney stone , but no stone. The pain comes in waves, like contractions. It is very painful and nothing helps. I don’t have this all the time. Often I will go for weeks, even months without this pain. Then all of a sudden it will start up again, and last for several days. I have had numerous blood test, urine tests and CT Scans. Nothing ever shows up. Any one else ever have this? Any ideas on what it could be? Thanks for your response.

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1. Cristela says:
  
  July 12, 2020 at 2:30 pm
  
  I am experiencing the same issue 😢.
  
  Reply
  1. Sherry says:
    
    July 24, 2020 at 1:17 am
    
    Same here
    
    Reply
    1. Christine says:
      
      August 7, 2020 at 8:45 pm
      
      Same exact thing – just happened today! My urologist is no help. Need to speak to my Rhemotologist. Has anyone had an answer to this?i know it’s kidney bc I’ve had stoned and a big surgery 20 years ago on the other side
      
      Reply
      1. Stephanie Mugica says:
        
        September 3, 2020 at 7:43 am
        
        Look up diverticulitis
    2. Dana Dunn says:
      
      October 29, 2020 at 3:38 am
      
      I have SLE, was diagnosed at 17, again at 25, I’m now 49. I have right flank pain, I get cysts, they are very painful, I had one burst once, it was like a hot poker shoved in my upper back. Have a doctor check protien and creatinine levels in your blood. If urine is foamy or cloudy with side pain it could be the reason. They can also do an ultrasound for cysts.
      
      Reply
2. Joyce McGuirk says:
  
  February 21, 2021 at 4:21 pm
  
  I’m experiencing the same thing- Between right hip, and right shoulder blade on my back … it’s driving me insane
  
  Reply
3. Crystal says:
  
  March 20, 2021 at 11:00 pm
  
  Experiencing the same. I can also feel the inflammation in the kidney when this happens. I also have random proteinuria episodes.
  
  Reply
Elizabeth Delgado says:

October 14, 2020 at 10:19 am

I am experiencing the same pain on my right kidney I’ve had blood work X-ray taken CT scans they see crystals there’s blood in the urine my pain gets so intense that I walk holding my ribs . My lower back is so painful but my doctors Or RA dr says there’s just flare ups how can I get my DR to listen to me I’m in so much pain my legs get so swollen my back of the knees feel so heavy or stiff when I walk they think I might of passed a stone but this pain on my kidney is so painful it’s hard to even sleep on the right side how can u get my RA to listen to me that I’m in a lot of pain ? Should I request a new RA dr?

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Georgeana says:

October 19, 2020 at 10:52 pm

I am in bad pain every day

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Michelle Lopez says:

January 11, 2021 at 7:52 am

Hi, I have been struggling with hives and facial edema or angioedema going on 2 years now. My labs come back extremely low on C3 and C4 complements and a low C1Q. The tests have come back a couple of times in the same manner, from my research I have seen that this points to SLE with Acquired angioedema. I am going to see a rheumatologist on the 15th but I have been retaining water at a rapid rate and am quite concerned about this. I can’t seem to stop it. Water pills seem to have slowed it but I am still gaining. Any advice?

Reply