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Renal replacement therapy in lupus nephritis.

Gabriella Moroni1, Francesca Tantardini, Claudio Ponticelli

  • 1Division of Nephrology, IRCCS Maggiore Hospital, Milan, Italy. ponticelli@policlinico.mi.it

Journal of Nephrology
|January 23, 2004
PubMed
Summary

Renal replacement therapy for lupus patients requires careful management due to potential partial kidney function recovery and risks associated with immunosuppression. Renal transplantation offers the best outcomes, though certain factors influence graft survival.

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Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • Systemic lupus erythematosus (SLE) frequently affects the kidneys, leading to end-stage renal disease (ESRD).
  • Management of renal replacement therapy (RRT) in lupus nephritis presents unique challenges compared to other causes of uremia.

Purpose of the Study:

  • To review the indications and outcomes of RRT, including dialysis and renal transplantation, for patients with lupus nephritis.
  • To highlight specific considerations for lupus patients undergoing RRT, such as potential renal function recovery, disease activity during dialysis, and risks associated with antiphospholipid antibodies.

Main Methods:

  • Review of existing literature on RRT in lupus nephritis patients.
  • Analysis of factors influencing outcomes in dialysis and renal transplantation for SLE patients.

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Main Results:

  • 10-28% of lupus patients on dialysis may experience partial renal function recovery, complicating treatment decisions.
  • Vigorous immunosuppression in uremic lupus patients carries risks of severe side-effects; subdued disease activity is common, but hectic activity can occur.
  • Antiphospholipid antibodies (aPL) increase the risk of vascular access thrombosis/stenosis.
  • Renal transplantation is the preferred RRT for ESRD in lupus patients, with generally comparable patient and graft survival rates to non-lupus recipients, especially with living donors.
  • Factors like aPL, Black race, and long-term dialysis increase graft failure risk.
  • Active lupus or significant morbidity necessitates delaying transplantation by 6-12 months.
  • Lupus nephritis recurrence ranges from 2-30%, typically with less severe histology.

Conclusions:

  • RRT choices for lupus nephritis should balance potential renal recovery against treatment risks.
  • Renal transplantation is highly effective, but careful patient selection and management of risk factors are crucial for optimal outcomes.
  • Management strategies for antiphospholipid antibodies, including antiplatelet agents or anticoagulation, are important for lupus patients undergoing RRT.