Update on Lupus Nephritis: Core Curriculum 2020

Abstract

Systemic lupus erythematosus is a multisystem autoimmune disease that commonly affects the kidneys. Lupus nephritis (LN) is the most common cause of kidney injury in systemic lupus erythematosus and a major risk factor for morbidity and mortality. The pathophysiology of LN is heterogeneous. Genetic and environmental factors likely contribute to this heterogeneity. Despite improved understanding of the pathogenesis of LN, treatment advances have been few and risk for kidney failure remains unacceptably high. This installment in the Core Curriculum of Nephrology provides an up-to-date review of the current understanding of LN epidemiology, pathogenesis, diagnosis, and treatment. Challenging issues such as the management of LN in pregnancy, timing of transplantation, and the evolving role of corticosteroid use in the management of LN are discussed. We review the currently accepted approach to care for patients with LN and highlight deficiencies that need to be addressed to better preserve long-term kidney health and improve outcomes in LN.

Keywords: Lupus nephritis (LN); complete response (CR); corticosteroids; cyclophosphamide; end-stage kidney disease (ESKD); glomerulonephritis (GN); histopathologic classification; induction therapy; kidney biopsy; lupus; maintenance therapy; mycophenolate mofetil (MMF); partial response (PR); pregnancy; proteinuria; review; rituximab; systemic lupus erythematosus (SLE).