Synopsis
Detect renal involvement in systemic lupus erythematosus, use timely biopsy and activity–chronicity assessment to select treatment, and coordinate modern combination therapy, monitoring and pregnancy planning.
- Lupus nephritis may be clinically silent, so every SLE review includes blood pressure, urinalysis, serum creatinine and quantitative proteinuria rather than waiting for oedema.
- New proteinuria, glomerular haematuria, casts or unexplained kidney dysfunction should trigger urgent combined renal and rheumatology review and timely kidney biopsy.
- Anti-dsDNA rise and C3 or C4 fall support immunological activity but neither proves a renal flare, excludes infection nor replaces urine and biopsy assessment.
Key red flags
Hypertension, glomerular blood, casts, rising creatinine and falling complement suggest active class III or IV disease and require urgent biopsy-led care.
Investigation priorities
Detect glomerular inflammation and quantify albumin and total protein loss.
Management branches
A person with SLE develops proteinuria, glomerular haematuria, casts, hypertension or unexplained renal dysfunction.
- Quantify proteinuria, inspect sediment, trend creatinine and pressure, and assess fluid state, extra-renal activity, infection, medicines and thrombosis.
- Send complement, dsDNA, blood count, CRP and cause-directed infection and antiphospholipid tests, treating sepsis and acute renal complications immediately.
Key medicines
HydroxychloroquineUse a weight- and renal-function-adjusted once-daily dose within the specialist SLE and ophthalmology plan.
Mycophenolic-acid analogueInduction and maintenance doses follow the combined renal–rheumatology protocol and are titrated for tolerance and response.