Update on Lupus Nephritis

Abstract

SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients. This review highlights recent updates in our understanding of disease epidemiology, genetics, pathogenesis, and treatment in an effort to establish a framework for lupus nephritis management that is patient-specific and oriented toward maintaining long-term kidney function in patients with lupus.

Keywords: Chronic; Discoid; Epidemiology and outcomes; Lupus Erythematosus; Renal Insufficiency; Systemic; chronic; glomerular disease; glomerulonephritis; humans; immunosuppression; kidney; kidney failure; lupus nephritis; nephritis; risk factors; systemic lupus erythematosus.

Figure 1.

A proposed algorithm for when to perform a kidney biopsy in patients with lupus nephritis (LN).

Figure 2.

Current induction and maintenance treatment choices for proliferative lupus nephritis. Patients are considered to have severe lupus nephritis if they have functional kidney injury with an elevated serum creatinine and/or heavy proteinuria, evidence that the loss of renal function occurred over a relatively short period of time and active histologic injury with glomerular crescents and necroses affecting several glomeruli. AZA, azathioprine; CSA, cyclosporine A; MMF, mycophenolate mofetil; TAC, tacrolimus.