Renal replacement therapy in lupus nephritis

Abstract

Treatment of lupus patients with haemodialysis has comparable results as in non-lupus patients. In contrast, during CAPD treatment peritonitis, other infectious complications and technique failure are more frequent in lupus patients, with an increased overall mortality. Therefore, haemodialysis is preferred over CAPD, especially if the patient is still using immunosuppressives. During both dialysis modalities in general, disease activity decreases, which enables tapering off immunosuppression. During pre-transplant screening, special attention should be given to cardiovascular disease manifestations, lupus disease activity, the presence of anti-phospholipid antibodies and anti-lymphocyte antibodies and bone mineral density. Lupus patients are good candidates for renal transplantation. If possible, lupus patients should be transplanted pre-emptively with a kidney from a living donor since this approach leads to the best results. We prefer maintenance immunosuppression after 6-12 months without calcineurin blockers because they bear a higher cardiovascular risk than for instance MMF. After renal transplantation lupus disease activity further declines. The rate of recurrence of lupus nephritis in the renal allograft is low (<4%). © The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.