Kidney Disease

3) 24-Hour urine collection

Studies of the urine collected by the patient over a 24-hour period determine whether the kidneys are working properly.

These studies measure the kidneys' ability to filter waste products:
-the creatinine clearance test
-the exact amount of protein lost in the urine over a 24-hour period.

4) Imaging studies

There are two ways to examine size and shape of the kidneys, which must be done before a kidney biopsy to help guide the physician doing the biopsy:

an intravenous pyelogram (IVP) involves an injection of dye that collects in the kidneys. An x-ray of the abdomen is then taken which shows the outline of the kidneys.

a sonogram uses soundwaves transmitted through the body to show the shape and size of the surfaces of the kidney.

5) Kidney biopsy

If urine or blood studies suggest lupus nephritis, a kidney biopsy may be performed. The biopsy is done to:

confirm the diagnosis of lupus nephritis
to determine the extent and severity of kidney disease.

A kidney biopsy is done in a hospital by inserting a narrow needle through the skin of the back and removing a small piece of the kidney. (On rare occasions, a kidney biopsy may need to be done surgically in the operating room.)

The specimen of kidney tissue is then examined under a microscope to determine how much inflammation or permanent damage (scarring) is present. These findings classify the type of lupus nephritis by using a scoring system devised by the World Health Organization (WHO) (see Table 1). Knowing the type of lupus nephritis helps to determine the seriousness of the nephritis and the best approach to treatment.

World Health Organization (WHO) Classification System for Lupus Nephritis

The World Health Organization has established a classification system for types of lupus nephritis, which are described in the table below.

Table 1. World Health Organization (WHO) Classification System for Lupus Nephritis

Class	Designation	Comment
I	Normal	No evidence of lupus nephritis on the kidney biopsy.
II	Mesangial Nephritis	Most mild form of lupus nephritis; typically responds completely to treatment with corticosteroids.
III	Focal Proliferative Nephritis	Very early stage of more advanced lupus nephritis; typically treated with high doses of corticosteroids, with excellent outcome.
IV	Diffuse Proliferative Nephritis	Advanced stage of lupus nephritis with definite risk of loss of kidney function; typically treated with high doses of corticosteriods combined with immunosuppressive drugs.
V	Lupus Membranous Nephropathy	Generally associated with excessive protein loss and edema; typically treated with high doses of corticosteroids, with or without immunosuppressive drugs.

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