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Review
. 2014 Sep;26(5):502-9.
doi: 10.1097/BOR.0000000000000089.

The pathogenesis, diagnosis and treatment of lupus nephritis

Noa Schwartz  1 , Beatrice Goilav, Chaim Putterman
Affiliations
Review

The pathogenesis, diagnosis and treatment of lupus nephritis

Noa Schwartz et al. Curr Opin Rheumatol. 2014 Sep.

Abstract

Purpose of review: Renal involvement is a major cause of morbidity and mortality in systemic lupus erythematosus. In this review, we provide an update on recent discoveries in the pathogenesis, diagnosis, and treatment of lupus nephritis.

Recent findings: Localized long-lived plasma cells have been identified as playing an important role in lupus nephritis. In addition, the roles of aberrant expression of microRNAs and proinflammatory cytokines have been explored. Early diagnosis is important for effective treatment and multiple biomarkers have been identified; however, none has been yet validated for clinical use. Biomarker panels may turn out to be more accurate than each individual component. Biologic agents for the treatment of lupus nephritis are being studied, including belimumab which was recently approved for nonrenal systemic lupus erythematosus. Rituximab has not proven itself in large, placebo-controlled trials, although it is still being used in refractory cases of lupus nephritis.

Summary: Lupus nephritis is a potentially devastating complication of systemic lupus erythematosus. Immune cells, cytokines, and epigenetic factors have all been recently implicated in lupus nephritis pathogenesis. These recent discoveries may enable a paradigm shift in the treatment of this complex disease, allowing the tailoring of treatment to target specific pathogenic mediators at specific points in time in the progression of disease.

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Conflict of interest statement

Conflict of Interest:

Drs. Schwartz and Goilav have no conflicts to report. Dr. Putterman has received research funds from Biogen Idec, is co-holder on a patent for the diagnostic use of TWEAK in LN, and is an investigator in the anti-TWEAK mAb in LN clinical trial.

Figures

Figure 1
Figure 1
Timeline of recent developments in the pathogenesis and treatment of lupus nephritis
See this image and copyright information in PMC

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