What Are the Classes, Signs, and Symptoms of Lupus Nephritis?

In the early stages of lupus nephritis, there are very few signs that anything is wrong. In fact, some patients have no specific symptoms. Kidney problems often start around the same time that lupus symptoms appear.

Symptoms of lupus nephritis are often:
Swelling, usually in legs, feet or ankles Weight gain
Fatigue Foamy, bubbly or frothy urine

Clinical signs of lupus nephritis include:

  • Leakage of a high level of protein into the urine (a condition known as proteinuria). Extra protein in the urine shows up in a clinical laboratory urine test.
  • Leakage of blood into the urine (a condition known as hematuria)
  • High blood pressure
  • Inflammation or scarring of the kidneys as confirmed through a kidney biopsy

Lupus Nephritis Classes and Related Signs and Symptoms

Lupus nephritis is divided into 6 different stages or classes based on the results of a kidney biopsy. Your doctor will describe these as classes. Of those people diagnosed with lupus nephritis, 70% will be diagnosed as having Class 3, 4 or 5. The following table provides an overview of these different classes as well as certain signs and symptoms that may occur during various stages.

Symptoms of lupus nephritis often include weight gain; swelling in the legs, feet, or ankles; and urine that is foamy, bubbly, or frothy. Additional signs and symptoms associated with the different classes of lupus nephritis are noted below.

Class Description Signs and Symptoms
Class 1
Minimal mesangial glomerulonephritis
Minimal kidney involvement No obvious symptoms
Class 2
Mesangial proliferative glomerulonephritis
Some evidence of inflammation in limited areas of the kidneys Microscopic amounts of blood in urine (a condition known as hematuria) and/or excess protein in urine (a condition known as proteinuria).
Class 3
Focal glomerulonephritis
Involvement of less than half of the network of small blood vessels in the kidneys

Blood and/or excess protein in urine

Possible high blood pressure

Class 4
Diffuse proliferative nephritis
Involvement of more than half of the network of small blood vessels in the kidneys

Blood and/or excess protein in urine

Possible high blood pressure

Class 5
Membranous glomerulonephritis
Characterized by immune deposits found around the network of small blood vessels

Different from other forms of lupus nephritis

Blood and/or excess protein in urine

Possible high blood pressure

Class 6
Advanced sclerotic
Damage to more than 90% of the network of small blood vessels in the kidneys Near or total kidney failure (dialysis or kidney transplant may be needed)

Based on 2003 classification by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS).

Higher than normal levels of PROTEIN IN THE URINE (a condition known as proteinuria) Key Feature of Lupus Nephritis:

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