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Review
. 2016 Sep;90(3):487-92.
doi: 10.1016/j.kint.2016.03.042. Epub 2016 Jun 22.

Insights into the epidemiology and management of lupus nephritis from the US rheumatologist's perspective

Paul J Hoover  1 , Karen H Costenbader  2
Affiliations
Review

Insights into the epidemiology and management of lupus nephritis from the US rheumatologist's perspective

Paul J Hoover et al. Kidney Int. 2016 Sep.

Abstract

Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that disproportionately affects nonwhites and those in lower socioeconomic groups. This review discusses recent data on the incidence, prevalence, and outcomes of patients with lupus nephritis with a focus on low-income US Medicaid patients. We also review recent guidelines on diagnosis, treatment, and screening for new onset and relapses of lupus nephritis. Finally, we discuss the management of lupus nephritis from a rheumatologist's perspective, including vigilance for the common adverse events related to disease and treatment, and we review prevention and new treatment strategies.

Keywords: epidemiology; glomerulonephritis; lupus.

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Figures

Figure 1
Figure 1
The prevalence of systemic lupus erythematosus (SLE) and lupus nephritis (LN) is inversely related to socioeconomic status (SES). Depiction of the prevalence of SLE and LN per per 100,000 US Medicaid enrollees aged 18–65 years old. Data are stratified by SES quartile where SES 1 (lowest) is < −1.62, SES 2 above −1.62 to −0.74, SES 3 = above −0.74 through 0.26, SES 4 [highest] = above 0.26). The results of crude analyses and analyses are adjusted for age group, sex, and ethnicity. Bars represent 95% confidence intervals.
Figure 2
Figure 2
The extent of interstitial nephritis severity correlates with renal survival. Applying a five-tier* measurement of interstitial inflammation Hsieh et al generate Kaplan-Meier curves of renal survival. Total conventional light microscopy (TLM) without subtracting areas containing interstitial fibrosis and tubular atrophy was used with standard histopathologic staining. The number of patients available for analysis in each grade is provided. P values were derived using a log rank trend test. *5 tier measure: none/grade 0=0%; minimal/grade 1= <10%, mild/grade 2= 10–25%, moderate/grade 3=26–50%; or severe/grade 4= >50%.
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