Visual summary
Persistent abnormalities can reflect active inflammation, scarring, a different lesion, or treatment-delivery problems. Do not escalate automatically without revisiting the explanation.
Text version
A spectrum of kidney lesions
Lupus can affect glomeruli, vessels, and interstitium. Clinical urine findings do not fully describe the class, activity, or chronicity of injury.
Recognize subtle disease
Hematuria or proteinuria may precede striking systemic activity. Quiet serologies do not reliably exclude important kidney pathology.
Integrate the evidence
Assess urine, filtration, protein loss, complement, serologies, medication exposure, infection, and biopsy when indicated.
Match treatment to disease
Choose induction and maintenance strategies according to pathology, severity, prior response, pregnancy plans, comorbidities, and treatment tolerance.
Monitor beyond response definitions
Infection, cytopenias, metabolic effects, fertility, adherence barriers, and cumulative toxicity matter alongside proteinuria and filtration.
Reassess apparent resistance
Persistent abnormalities can reflect active inflammation, scarring, a different lesion, or treatment-delivery problems. Do not escalate automatically without revisiting the explanation.
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