From the Guidelines
Lupus nephritis symptoms include foamy urine, blood in the urine, high blood pressure, swelling in the legs, ankles, or around the eyes, increased urination (especially at night), and fatigue, and can be effectively managed with immunosuppressive medications as recommended by the latest guidelines 1. Lupus nephritis is a major cause of morbidity in patients with systemic lupus erythematosus (SLE), with up to 40% of patients developing kidney disease 1. The symptoms of lupus nephritis can vary, but common signs include:
- Foamy urine
- Blood in the urine
- High blood pressure
- Swelling in the legs, ankles, or around the eyes
- Increased urination (especially at night)
- Fatigue Patients may also experience joint pain, skin rashes, fever, and weight gain due to fluid retention. Laboratory findings typically show protein in the urine (proteinuria), red blood cells in urine (hematuria), elevated creatinine levels, and decreased kidney function. According to the latest KDIGO 2024 clinical practice guideline for the management of lupus nephritis, the management of patients with pure Class V lupus nephritis should be guided by the severity of proteinuria, and treatment with immunosuppressive medications such as voclosporin, prednisone, cyclophosphamide, or rituximab can help reduce proteinuria and prevent kidney failure 1. The use of immunosuppressive medications, such as prednisone plus cyclophosphamide or prednisone plus cyclosporine, has been shown to be effective in inducing remission in patients with Class V lupus nephritis, with response rates of 40%–60% 1. Early detection and treatment of lupus nephritis are crucial to prevent permanent kidney damage and improve patient outcomes. Regular kidney function monitoring in lupus patients is essential to detect kidney damage early, and prompt treatment with immunosuppressive medications can help prevent kidney failure 1.
From the FDA Drug Label
The primary efficacy endpoint was Primary Efficacy Renal Response (PERR) at Week 104, defined as a response at Week 100 confirmed by a repeat measurement at Week 104 of the following parameters: urine protein:creatinine ratio (uPCR) ≤0.7 g/g and estimated glomerular filtration rate (eGFR) ≥60 mL/min/1. 73 m2 or no decrease in eGFR of >20% from pre-flare value. The major secondary endpoints included:
- Complete Renal Response (CRR) defined as a response at Week 100 confirmed by a repeat measurement at Week 104 of the following parameters: uPCR <0.5 g/g and eGFR ≥90 mL/min/1. 73 m2 or no decrease in eGFR of >10% from pre-flare value.
- PERR at Week 52
- Time to renal-related event or death (renal-related event defined as first event of end-stage renal disease, doubling of serum creatinine, renal worsening [defined by quantified increase in proteinuria and/or impaired renal function], or receipt of renal disease-related prohibited therapy due to inadequate lupus nephritis control or renal flare management)
The symptoms of lupus nephritis are not directly listed in the provided drug label. However, the label does describe the parameters used to measure Primary Efficacy Renal Response (PERR) and Complete Renal Response (CRR), which include:
- Urine protein:creatinine ratio (uPCR)
- Estimated glomerular filtration rate (eGFR) These parameters suggest that lupus nephritis symptoms may include proteinuria (excess protein in the urine) and impaired renal function. 2
From the Research
Lupus Nephritis Symptoms
Lupus nephritis is a complication of systemic lupus erythematosus (SLE) that affects the kidneys. The symptoms of lupus nephritis can vary, but they often include:
- Proteinuria (excess protein in the urine) 3, 4, 5, 6, 7
- Hematuria (blood in the urine) 3, 4, 5, 6, 7
- Elevated serum creatinine levels 3, 4, 5, 6, 7
- Decreased kidney function 3, 4, 5, 6, 7
- Systemic symptoms such as fever, fatigue, and weight loss 3, 4, 5, 6, 7
Treatment Options
Treatment options for lupus nephritis include:
- Mycophenolate mofetil (MMF) 3, 4, 5, 6, 7
- Intravenous cyclophosphamide (IVC) 3, 4, 5, 6, 7
- Corticosteroids 3, 4, 5, 6, 7
- Combination therapy with MMF and IVC 4
- Combination therapy with MMF and cyclosporine A 4
Response to Treatment
The response to treatment for lupus nephritis can vary, but studies have shown that:
- MMF can be effective in reducing proteinuria and improving kidney function 3, 4, 5, 6, 7
- IVC can also be effective in reducing proteinuria and improving kidney function, but may have more side effects 3, 4, 5, 6, 7
- Combination therapy with MMF and IVC or cyclosporine A may be effective in reducing proteinuria and improving kidney function in patients with persistent proteinuria 4