People with lupus are often at a higher risk of developing renal failure due to an autoimmune reaction. Medications can help prevent kidney damage by reducing immune activity.

Lupus is an autoimmune disease where your body attacks healthy tissue, causing organ damage and inflammation. The most common type of lupus is medically known as systemic lupus erythematosus (SLE).

People with SLE can develop inflammation in many parts of their bodies, but the kidneys are one of the most commonly affected areas. Renal failure, also called kidney failure, is very common in people with SLE since chronic inflammation can weaken kidney function.

Learn more about the connection between lupus and renal failure, symptoms to look out for, and treatment options.

Lupus can damage organs throughout the body, including the kidneys. People with lupus produce autoantibodies, which are special molecules that tell the immune system to attack its own tissues.

If doctors find evidence that these autoantibodies are inside your kidneys with a kidney biopsy, they may diagnose you with lupus nephritis. Nephritis refers to inflammation of your kidneys.

Approximately 40% of people with SLE develop lupus nephritis. Around 10–30% of these people progress to end stage kidney failure within 10 years. End stage kidney failure means your kidneys can no longer function well enough to support your body’s needs.

About 7–31% of people with SLE have lupus nephritis when they’re first diagnosed with SLE.

Other places where autoantibodies are commonly found include your:

  • skin
  • joints
  • blood cells
  • brain
  • heart
  • lungs

Lupus nephritis may cause foamy urine and swelling in your body due to extra fluid retention in places such as your legs and feet. This extra fluid may also lead to high blood pressure.

Kidney involvement usually develops three to five years after the onset of SLE.

Kidney failure may not cause noticeable symptoms in the early stages until it progresses enough that your kidneys can no longer meet your body’s needs. Once this happens, you may develop symptoms such as:

You may also develop other typical symptoms of lupus such as:

  • joint pain
  • muscle pain
  • fever
  • “butterfly rash” on your face

Regular monitoring of your kidney health is required if you’ve previously been diagnosed with lupus to prevent or minimize long-term kidney damage.

A kidney biopsy is mandatory for confirming a diagnosis of lupus nephritis. It involves taking a small tissue sample of your kidney with a long, thin needle.

Monitoring tests

The main types of tests doctors use to monitor the progression of kidney disease in people with lupus are blood and urine tests.

During a blood test, a doctor will examine your glomerular filtration rate (GFR). GFR measures how well your kidneys filter your blood. Anything under 15 mL/min/1.73 m2 is considered a marker of end stage renal failure.

During a urine test, a healthcare professional will look for a type of protein called albumin. Typically, your kidneys don’t let this protein pass from your blood to your urine. Finding it in your urine can be a sign that your kidneys are not functioning properly.

The main way that kidney failure is treated in people with lupus is with medications to reduce inflammation in the kidneys and decrease immune system activity.

Doctors often prescribe a class of medications called corticosteroids, such as prednisone, to help manage symptoms.

If you have SLE, you may also receive other medications to suppress immune system activity such as:

  • cyclophosphamide
  • mycophenolate mofetil
  • hydroxychloroquine

Treating risk factors that contribute to the development of end stage kidney disease may help slow kidney damage. Treatments you might receive include:

  • statin therapy to manage lipid levels
  • angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers for high blood pressure
  • vitamin D or vitamin E supplementation, along with omega-3 fatty acids to help improve inflammatory markers

Survival rates for SLE are around 85–90% 10 years after diagnosis. Receiving an early diagnosis and treatment is generally associated with a better outlook than a delayed diagnosis.

Kidney disease remains one of the most common causes of death in people with lupus if it is not caught and treated early.

In a 2024 study, researchers reported a complete response rate of 62% and an additional 5% receiving a partial response in people with lupus nephritis taking immunosuppressants.

Of people who respond to immunosuppressants, around a third seem to relapse.

Lupus can cause kidney failure due to an autoimmune reaction, where the immune system mistakenly attacks its own tissues.

The first signs of lupus nephritis are typically:

  • swelling in the legs, ankles, or feet
  • shortness of breath
  • fatigue
  • high blood pressure

Kidney failure is common in people with lupus. It can develop due to chronic inflammation that damages your kidneys’ inner structure and impairs their function.

If you’re diagnosed with lupus, it’s important to connect with a healthcare professional regularly to monitor for signs of kidney disease. Receiving early treatment can help reduce damage to your kidneys and may improve your overall outlook.