Lupus Nephritis: Signs, Tests, Treatment and Protecting Your Kidneys

By Anna Curran, RN, BSN, PHN · Last reviewed October 2026

Lupus nephritis is kidney inflammation caused by systemic lupus erythematosus (SLE). The immune system attacks the tiny filters in the kidneys, so they leak protein and blood into the urine and cannot clean the blood as well. Early on it often causes no pain, which is why regular urine and blood tests are so important.

The good news is that lupus nephritis can be treated, and options have grown in the last few years. Catching it early gives you the best chance of keeping your kidneys healthy. Here is what to know.

What Is Lupus Nephritis?

Your kidneys filter waste and extra fluid out of your blood. They also help control your blood pressure.

In lupus, the immune system makes antibodies that attack your own tissues. When this happens in the kidneys, it causes inflammation in the filtering units. Over time, inflammation can scar the kidneys and make them work less well.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports that:

About 5 in 10 adults with lupus develop kidney disease
About 8 in 10 children with lupus develop kidney disease
Between 10% and 30% of people with lupus nephritis develop kidney failure

Those last numbers sound scary. But NIDDK also notes that treatment often works well to control the disease, so these problems may never happen.

Who Is at Risk?

Anyone with SLE can develop lupus nephritis. According to NIDDK, it is more likely in:

Children and teens with lupus, who get kidney disease more often than adults
African Americans, Hispanic and Latino people, and Asian Americans, who are more likely than white people to develop lupus nephritis

It can start at any time, which is why your rheumatologist keeps checking your kidneys for as long as you have lupus.

Signs and Symptoms of Lupus Nephritis

Many people feel fine when kidney problems first start. When signs do appear, NIDDK lists:

Foamy or bubbly urine. This can be a sign of protein leaking into the urine.
Swelling (edema). It is most often in the legs, feet or ankles. Less often, it shows up in the hands or face.
High blood pressure. You usually cannot feel this, so it needs to be checked.

Other signs to tell your doctor about include pink, red or cola-colored urine, puffiness around the eyes and sudden weight gain from fluid. You may also have other lupus symptoms at the same time, like joint pain, fever or a rash. For more, see our guide to lupus symptoms.

Call your doctor soon if you notice foamy or dark urine, new swelling or a high blood pressure reading at home.

Tests for Lupus Nephritis

Because early lupus nephritis is often silent, testing is how it gets caught. The 2024 American College of Rheumatology (ACR) lupus nephritis guideline recommends that everyone with SLE be screened for protein in the urine every 6 to 12 months, and at the time of a flare.

Urine tests

Urine dipstick: Checks for protein and blood.
Urine under a microscope: Looks for red blood cells and other signs of kidney damage.
Urine protein-to-creatinine ratio: A single urine sample that estimates how much protein you are losing.
24-hour urine collection: You collect all your urine for a full day. Mayo Clinic lists this as one way to measure kidney function.

Blood tests

A blood test measures creatinine, a waste product your kidneys normally remove. NIDDK explains that creatinine rises as kidney disease gets worse. The result is used to estimate your glomerular filtration rate (GFR), which shows how well your kidneys are filtering.

Your doctor may also check blood counts, other lupus blood tests and your cholesterol.

Kidney biopsy

A biopsy is the test that confirms lupus nephritis. A doctor uses a thin needle to take a tiny piece of kidney tissue, which is studied under a microscope.

A biopsy shows:

What type, or class, of lupus nephritis you have
How active the inflammation is
Whether there is any scarring

This helps your doctor choose the right treatment. The 2024 ACR guideline recommends a prompt biopsy when lupus nephritis is suspected. Mayo Clinic notes that some people have more than one biopsy over time.

Treatment for Lupus Nephritis in 2026

The goals of treatment are to calm the inflammation, stop kidney damage and avoid dialysis or a kidney transplant. Mayo Clinic notes there is no cure, but treatment can control the disease.

Triple therapy is now the starting point

The 2024 ACR guideline recommends that active, new or flaring lupus nephritis be treated with triple therapy. This means steroids plus two other immune medicines. For the most common types (class III and IV), that usually means:

A steroid, such as prednisone
Mycophenolate
Plus either belimumab or a calcineurin inhibitor such as voclosporin or tacrolimus

The guideline suggests staying on treatment for at least 3 to 5 years. Cyclophosphamide may be used in some cases.

The ACR also strongly recommends hydroxychloroquine for everyone with SLE, including people with lupus nephritis.

FDA-approved medicines for lupus nephritis

As of October 2026, three medicines have FDA approval specifically for lupus nephritis. Each is used along with standard treatment.

Medicine	FDA approval for lupus nephritis	Who it is approved for
Belimumab (Benlysta)	December 2020 for adults; July 2022 for children	Adults, and children ages 5 to 17
Voclosporin (Lupkynis)	January 2021	Adults
Obinutuzumab (Gazyva)	October 2025	Adults

Obinutuzumab is the newest. It targets B cells, the immune cells that make antibodies. It is given by IV: four doses in the first year, then twice a year. In the main study, 46.4% of people who got obinutuzumab plus standard treatment had a complete kidney response, compared with 33.1% on standard treatment alone.

As of late 2026, the FDA is also reviewing obinutuzumab for SLE in general, with a decision expected by December 2026. That would be a separate approval from lupus nephritis.

For more about each lupus medicine, see our guide to lupus treatment options.

Blood pressure medicines

Blood pressure control protects your kidneys. NIDDK lists several types used in lupus nephritis. ACE inhibitors and ARBs are often chosen because they may also help protect the kidneys and lower protein in the urine. Diuretics (water pills) may be used to reduce swelling.

Never start, stop or change any medicine on your own. Talk with your doctor first.

Protecting Your Kidneys Day to Day

Medicine does the heavy lifting, but daily habits help too.

Keep every lab appointment. Urine and blood tests catch changes before you feel them.
Check your blood pressure at home if your doctor asks you to. Write down your numbers and bring them to visits.
Cut back on salt. NIDDK notes that eating less sodium may help lower high blood pressure. Mayo Clinic adds that limiting salt and protein may help the kidneys work better.
Ask for a dietitian. NIDDK suggests a dietitian can help with meal planning. Do not cut protein on your own without guidance.
Ask before taking pain relievers. Check with your doctor or pharmacist before using over-the-counter pain medicine like ibuprofen or naproxen.
Tell every provider you have lupus nephritis.
Take your medicines as prescribed. A pill organizer and phone alarms can help.
Do not smoke.
Plan pregnancy ahead. Some lupus nephritis medicines are not safe in pregnancy. Talk with your rheumatologist before trying to conceive.

Many lupus nephritis medicines lower your ability to fight infection. Call your doctor the same day for a fever, chills or burning when you urinate.

When to Call 911 or Go to the ER

Get emergency help right away if you have:

Trouble breathing or severe shortness of breath
Chest pain or pressure
Very little or no urine
Sudden, severe swelling with trouble breathing
A seizure, or sudden confusion
Signs of a stroke: face drooping, weakness on one side, trouble speaking or sudden vision loss
A very high blood pressure reading with a severe headache, chest pain or vision changes

Frequently Asked Questions

Can lupus nephritis be cured?

There is no cure, but it can be controlled. Treatment can calm the inflammation and help protect kidney function. Ongoing checkups help catch any return early.

Does everyone with lupus get kidney problems?

No. About half of adults with lupus develop kidney disease, according to NIDDK. Regular urine tests are the best way to know if your kidneys are affected.

How often should my urine be checked?

The 2024 ACR guideline recommends checking everyone with SLE for urine protein every 6 to 12 months, and during a flare. Your doctor may check more often if you already have kidney involvement.

Will I need dialysis?

Most people with lupus nephritis do not. NIDDK reports that 10% to 30% develop kidney failure. Early, steady treatment lowers that risk.

The Bottom Line

Lupus nephritis is kidney inflammation caused by lupus, and it often has no symptoms at first. Foamy urine, swelling and high blood pressure are signs to report, and regular urine tests catch it early. Treatment now starts with triple therapy, and belimumab, voclosporin and obinutuzumab are FDA-approved options. Keeping your blood pressure down, limiting salt and keeping every lab visit help protect your kidneys for the long run.