Not all people with lupus will require a kidney transplant. However, if they experience inflammation of the kidneys, known as lupus nephritis, they may require a kidney transplant depending on severity.

Lupus, a long-term (chronic) autoimmune disease, affects millions of people worldwide. This condition occurs when the immune system mistakenly attacks healthy tissues and organs, leading to widespread inflammation and various symptoms.

Lupus most often affects the kidneys. This can result in a condition known as lupus nephritis. As lupus progresses, individuals might need a kidney transplant to have fully functioning kidneys again.

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Lupus is a chronic autoimmune disease in which the immune system attacks the body’s cells and organs. There are several types of lupus, with systemic lupus erythematosus (SLE) being the most common.

Lupus nephritis is a type of kidney disease that 5 out of 10 adults with SLE may develop. In children living with lupus, 8 out of 10 may develop kidney disease. It occurs when inflammation in the kidneys causes them to stop working effectively.

The severity of lupus nephritis can vary if left untreated or not managed well. Lupus nephritis can progress to end stage renal disease (ESRD), a condition where the kidneys are functioning at less than 10–15% of their typical capacity.

At this advanced stage, individuals often require renal replacement therapy, such as dialysis or a kidney transplant, to sustain life.

Currently, the exact cause of lupus nephritis is unknown. However, health experts believe it may occur due to lupus affecting the kidneys through a combination of autoimmune and genetic factors.

Lupus triggers a reaction that creates immune complexes. This is where antigens (markers that tell the body something is foreign) bind to antibodies (a protective protein from the immune system). These immune complexes can settle near the kidneys and initiate an inflammatory response, eventually leading to damage and lupus nephritis.

Genetics also plays a crucial role in the occurrence of lupus and lupus nephritis. The genetic influence involves multiple genes, and its complete understanding remains a work in progress.

Ultimately, a combination of these factors results in the formation of glomerular immune complexes, which damage the kidneys.

A person living with lupus nephritis will require a transplant when the damage to the kidneys means they are unable to clear the body of waste products.

One way a healthcare professional may assess this is by using a glomerular filtration rate (GFR) test. This test can show how well the kidneys are working. A GFR of 15 milliliters or less per minute suggests kidney failure and that a person may require dialysis or a transplant.

Before recommending a kidney transplant, healthcare professionals will assess whether a person meets the criteria for a kidney transplant. They may consider things such as:

  • Overall health (excluding kidney issues): Due to the physically demanding nature of a transplant, a healthcare professional will want to ensure a person can recover sufficiently from the procedure.
  • Severity of kidney damage: Healthcare professionals may give higher priority to people experiencing kidney failure.
  • Mental health: This is to make sure that the individual is mentally prepared for the challenges that come with the transplant process and post-transplant care.

Finding a suitable kidney donor is a critical aspect of the transplant process.

Kidney donors can either be living or deceased. Living donors are the preference as their kidneys tend to function better and have a higher success rate in transplantation. Family members, friends, or altruistic donors can volunteer to be living donors.

To find a suitable kidney donor, a person will undergo a cross-matching process. This involves the transplant team testing the blood of a potential donor against the blood of the person expecting the transplant. This helps predict whether the body will accept the new kidney.

In the United States, most people wait 3–5 years for a kidney transplant. However, waiting time can vary significantly depending on factors such as severity, tissue compatibility, and the availability of suitable donors.

Kidney transplant surgery is a major procedure that involves removing the affected kidney, or kidneys, and replacing it with a suitable donor kidney.

As soon as a kidney is available, a person will need to go to the hospital to have the transplant.

Prior to the surgery, a person will receive general anesthesia. Surgery typically takes 3–4 hours and involves the surgeon placing the healthy kidney into the body. Often, the surgeon will transplant a kidney through the lower abdomen, near the groin.

After the transplant, recipients will require regular follow-up appointments and ongoing medical care. This is to monitor kidney function and address any potential complications.

Lupus is a chronic autoimmune condition that can damage the kidneys. Not all individuals with lupus will require a kidney transplant. However, those who develop lupus nephritis, a complication where inflammation damages the kidneys, may require the procedure.

A healthcare professional may recommend a transplant in cases where the kidneys are damaged and cannot work as usual.