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
1. impaired renal function
2. fluid and electrolyte imbalance
3. Increased risk of infection
SLE Nephropathy Signs and
Potential Renal Manifestations
Signs and Symptoms Suggesting
- hematuria (as few as 5 RBCs is
- proteinuria (>1+)
- sterile pyuria
- elevated creatinine level
(indicates loss of renal function)
- elevated blood urea nitrogen
- weight gain
- ankle edema
Fluid and Electrolyte Imbalance
(Excess Extracellular Fluid Volume)
- nausea and vomiting
- changing level of consciousness
Urinary Tract Infection
- weight gain
- pitting edema of the lower
- sacral edema
- bounding pulse, elevated blood
pressure, S3 gallop
- engorgement of neck and hand
- crackles in lungs
- 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
- Frequent urination
- Urgent need to urinate
- Cloudy urine
- Incomplete emptying of the bladder
- Low back or suprapubic pain
- Flank pain
- Nausea and vomiting
Objective: Promptly recognize
renal involvement and prevent
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),
(hematuria), or nocturia and
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
6. Stress the importance of
referral and followup care with
nephrologist if necessary.
Objective: Decrease fluid retention
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
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
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