Update on the current therapies of lupus nephritis

Abstract

Renal disease is a major organ manifestation of systemic lupus erythematosus (SLE) and carries significant morbidity and mortality. Lupus nephritis is more common in certain ethnic groups such as Africans, Hispanics and Asians. The prognosis of lupus nephritis is determined by a large number of clinicopathological, genetic and socioeconomic factors. The choice of treatment should be based on risk stratification of individual patients. Cyclophosphamide (CYC) remains the preferred treatment for high-risk patients. For other patients, mycophenolate mofetil is an excellent and less toxic alternative to CYC. Evidence regarding the calcineurin inhibitors in lupus nephritis is less strong but they can be considered in patients who are refractory or intolerant to other immunosuppressive agents. For refractory lupus nephritis, a repeat renal biopsy is mandatory and newer modalities such as B-cell depletion can be considered. Finally, adjunctive measures such as the angiotensin converting enzyme inhibitors and the angiotensin II receptor antagonists, vigorous control of hypertension and lipid level should be contemplated early in the course of the disease. © 2006 Asia Pacific League of Associations for Rheumatology.