Patient information · Rheumatology
Lupus
why the kidneys must be checked even when you feel well
Lupus is an autoimmune condition in which the immune system attacks the body's own tissues. It affects joints, skin, blood and internal organs, runs a relapsing course, and is considerably more common in women and in people of African, Caribbean, South Asian and Chinese heritage — in whom it also tends to be more severe.
Seek urgent assessment if you have
- chest pain worse on breathing in, or breathlessness
- severe headache, confusion, seizures or visual change
- swelling of the legs or face, or frothy urine
- fever while on immunosuppressive treatment
- unusual bruising or bleeding
- a painful, swollen calf, or sudden breathlessness
People with lupus have a substantially raised clot risk, particularly with antiphospholipid antibodies. Fever on immunosuppression needs same-day assessment because infection can be difficult to distinguish from a flare. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Symptoms
- Fatigue — the commonest and most disabling symptom
- Joint pain and swelling, often in the hands and wrists, usually without the erosive damage of rheumatoid arthritis
- Rashes — the butterfly rash across the cheeks and nose, and discoid patches. Photosensitivity: rashes or feeling unwell after sun exposure
- Mouth or nose ulcers, usually painless, and hair thinning
- Raynaud's, fevers, weight loss, swollen glands
- Kidney involvement, which is usually silent until advanced
- Miscarriage or clots, particularly with antiphospholipid antibodies
A positive ANA does not mean lupus
Antinuclear antibody is positive in around one in eight healthy people, rising with age, and in many other conditions. On its own it means very little, and a great deal of unnecessary alarm comes from a positive ANA reported without context. Diagnosis requires the clinical picture plus more specific tests — anti-dsDNA and anti-Sm are far more specific, and low complement levels (C3, C4) indicate active disease. Equally, lupus is occasionally diagnosed in someone with a low-titre ANA. The test supports the diagnosis; it does not make it.
The test that gets forgotten
Lupus nephritis affects up to half of people with lupus and causes no symptoms until it is advanced. It is detected by a simple urine test for protein (ACR) alongside blood pressure and kidney function — and it should be checked at every review, not only when you feel unwell. Kidney involvement found early is very treatable; found late it can lead to dialysis. If you have lupus and have not had a urine test in the last few months, ask for one.
Treatment
- Hydroxychloroquine for almost everyone with lupus, indefinitely. It reduces flares, protects the kidneys, lowers clot risk and improves survival. It is one of the most valuable drugs in rheumatology.
- Annual eye monitoring is required with hydroxychloroquine after five years, as retinal toxicity is rare but serious and detected before any symptoms appear.
- Steroids for flares, at the lowest dose for the shortest time.
- Immunosuppressants — methotrexate, azathioprine, mycophenolate — and biologics for more severe disease.
- Blood pressure and cholesterol control, because cardiovascular risk is markedly raised by the inflammation itself.
- Bone protection with steroid use, and vitamin D.
Living with it
Do
- Use SPF 50 daily and cover up — sun triggers both rashes and systemic flares
- Keep taking hydroxychloroquine even when well
- Have flu, COVID and pneumococcal vaccination; avoid live vaccines on immunosuppression
- Plan pregnancy in advance — several medicines must be changed first
- Pace activity, and treat fatigue as a symptom rather than a failing
Watch for
- Assuming every symptom is lupus — infection mimics flares
- Stopping medication when you feel well
- Combined hormonal contraception if you have antiphospholipid antibodies
- Skipping urine tests, which are how kidney disease is caught
- Smoking, which worsens disease and reduces hydroxychloroquine's effect
Why come to us. Lupus is diagnosed late partly because the symptoms are scattered across specialties. We take the full autoimmune panel — ANA, dsDNA, ENA, complement, inflammatory markers, full blood count — plus urine ACR and kidney function in-house, with results explained in one visit rather than accumulated over months. Where the picture fits, we refer to rheumatology promptly with the workup complete. Seven days a week, no referral needed.
The full autoimmune panel, explained in one visit
Bloods and urine ACR in-house. Seven days a week, no referral.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.