Lupus nephritis is often silent until it is advanced, so it has to be looked for. At every visit for a patient with systemic lupus, check blood pressure, dipstick a fresh urine sample for blood and protein, and quantify any protein with a spot urine protein-to-creatinine ratio. Look at the urine sediment for red cell casts when blood is present. Check creatinine and eGFR, and follow anti-dsDNA and C3, which often change before the kidney does. A new rise in protein or active sediment is a reason for prompt nephrology input and consideration of biopsy.
- Dipstick fresh urine and check blood pressure at every lupus visit
- Quantify proteinuria with a spot urine protein-to-creatinine ratio
- Look for red cell casts when haematuria is present
- Track creatinine, anti-dsDNA and C3 for early warning
Why it matters
Early detection of nephritis is the main way to preserve kidney function in lupus.
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