Overview

Renal damage is one of the most serious complications of SLE. The majority of people with lupus have some degree of asymptomatic microscopic kidney damage. Fifty percent have clinical renal disease. Kidney damage may necessitate treatment with corticosteroids, cytotoxic agents, dialysis, or renal transplantation.

Renal biopsy can be helpful in making decisions about drug treatments and determining prognosis by assessing the presence of active renal disease versus scarring.

Potential Problems

1. impaired renal function

2. fluid and electrolyte imbalance

3. Increased risk of infection

Potential Renal Manifestations SLE Nephropathy Signs and Symptoms: hematuria (as few as 5 RBCs is significant) proteinuria (>1+) sterile pyuria elevated creatinine level (indicates loss of renal function) elevated blood urea nitrogen (BUN) weight gain ankle edema hypertension Signs and Symptoms Suggesting Renal Failure nausea and vomiting anorexia anemia lethargy pruritus changing level of consciousness Fluid and Electrolyte Imbalance (Excess Extracellular Fluid Volume) weight gain pitting edema of the lower extremities sacral edema bounding pulse, elevated blood pressure, S3 gallop engorgement of neck and hand veins dyspnea crackles in lungs cyanosis decreased hematocrit urine specific gravity <1.010 variable serum sodium level (normal, high, or low), depending on the amount of sodium retention or water retention serum osmolality <275 mOsm/kg Urinary Tract Infection Dysuria Frequent urination Urgent need to urinate Fever Cloudy urine Incomplete emptying of the bladder Low back or suprapubic pain Flank pain Malaise Nausea and vomiting

Nursing Interventions

Objective: Promptly recognize renal involvement and prevent complications.

1. Document any patient complaints or assessment findings that may indicate renal involvement.

2. Teach the patient to watch for signs and symptoms of renal complications and report them promptly to the physician: facial swelling, peripheral edema, "foamy" urine (proteinuria), "coke-colored" urine (hematuria), or nocturia and urinary frequency.

3. Assess the patient for early signs of heart failure.

4. Refer the patient to a dietitian for counseling on dietary changes to accommodate alterations in renal status.

5. Teach the patient to take prescribed medications as ordered.

6. Stress the importance of referral and followup care with nephrologist if necessary.

Objective: Decrease fluid retention and edema.

1. Monitor electrolyte values.

2. Assess breath sounds and instruct the patient to report shortness of breath or dyspnea.

3. Teach the patient to maintain balanced fluid intake and output.

4. Monitor the patient for signs and symptoms of extracellular fluid overload.

5. Instruct the patient to weigh herself or himself daily to monitor fluid retention.

6. Monitor the patient's blood pressure and teach the patient how to monitor it at home.

Objective: Minimize risk of infection.

1. Teach the patient to watch for the signs and symptoms of urinary tract infection and to report them to the physician.

2. Instruct the patient that corticosteroid therapy may mask the usual symptoms of infection and that she or he may have an altered immune response because of medications used to control SLE.

3. Teach the patient to take antibiotics for urinary tract infection as prescribed.

Note: For additional information, see the Patient Information Sheet on Serious Conditions Associated With Lupus.



Source: National Institutes of Health, U.S.Dept of Health and Human Services