Is class IV lupus nephritis curable at age 28?

Question

Hello doctor,

I am really scared because my 28-year-old daughter was just diagnosed with lupus nephritis after having protein in her urine and swelling in her face and legs for the past two months. Her kidney biopsy showed class IV lupus nephritis, and creatinine went up to 2.1 mg/dL from normal levels six months ago.

The rheumatologist started her on Prednisone 60 mg daily and Mycophenolate, but she is having terrible side effects, such as mood swings, weight gain, and her face is all puffy. Her periods stopped completely since starting the medications, and she is worried about fertility because she wants kids someday.

The protein in her urine is still high (above three), and blood pressure keeps going up even on Lisinopril. She also has a butterfly rash on her cheeks that gets worse in sunlight. She even tried Hydroxychloroquine, but it gave her stomach problems, and she had to stop. The nephrologist wants to add Rituximab infusions, but shes scared about getting infections.

Can lupus nephritis affect pregnancy if she gets better?
Also worried this might be genetic because her aunt had kidney problems too.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Lupus nephritis means her immune system is attacking her kidneys. Class IV is a serious form, but it is treatable with strong medicines.

Her creatinine of 2.1 mg/dL indicates active kidney inflammation. The goal now is to stop further damage and reduce protein in urine. Early, aggressive treatment improves long-term kidney survival.

High-dose Prednisone (60 mg) commonly causes a puffy face, mood swings, weight gain, and menstrual changes. Periods often stop temporarily due to stress and high steroid doses. In most young women, cycles return once steroids are reduced.

Mycophenolate mofetil is important to control kidney inflammation. It does not usually cause permanent infertility, but it must not be taken during pregnancy. If pregnancy is planned in the future, medicines can be changed once the disease is stable.

If the protein is still three and the blood pressure is high, it means the disease is still active. Strict blood pressure control is very important to protect the kidneys. Sometimes a dose adjustment or adding another medicine is needed.

The butterfly rash and sun sensitivity are classic signs of systemic lupus erythematosus (a chronic, unpredictable autoimmune disease where the immune system attacks healthy tissues, causing widespread inflammation and damage to organs). Sun protection is very important, including sunscreen, an umbrella, and avoiding midday sun.

If Hydroxychloroquine caused stomach upset, sometimes lowering the dose or taking it after food helps. It is actually protective for lupus long-term, so doctors often try to continue if possible.

Rituximab is used when the disease is severe or not responding. Yes, infection risk increases, but patients are monitored closely. Sometimes it helps avoid long-term high steroids.

Regarding pregnancy, many women with lupus nephritis can have a successful pregnancy, but only when the disease is well-controlled for at least six months. Active kidney disease during pregnancy can be risky.

Lupus is not strongly genetic, but there is some family tendency. It does not mean her children will definitely have it.

Right now, the priority is controlling kidney inflammation. Once the disease is stable, fertility and pregnancy planning can be discussed safely with the rheumatologist and nephrologist together.

This is serious, but many young women respond well and live normal lives with proper treatment and monitoring.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.