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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Therapeutic options for resistant lupus nephritis
1Department of Medicine, Tuen Mun Hospital, Hong Kong, SAR China. ccmok2005@yahoo.com
Seminars in Arthritis and Rheumatism
|August 4, 2006
Summary
Treatment options for refractory lupus nephritis are limited and largely anecdotal. Newer immunosuppressants and biologics show promise, but controlled trials are needed to establish efficacy and standardized response criteria for lupus nephritis.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Lupus nephritis is a severe complication of systemic lupus erythematosus.
- Treatment resistance is a significant challenge in managing proliferative and membranous lupus nephritis.
Purpose of the Study:
- To summarize therapeutic options for lupus nephritis resistant to conventional treatments.
- To review evidence for newer immunosuppressive drugs, immunomodulatory therapies, and biological agents.
Main Methods:
- A Medline search of English literature from 1985-2005 was conducted.
- Keywords included various terms for lupus nephritis, treatment resistance, and specific therapies.
- Exclusion criteria focused on laboratory, histological, and non-renal lupus studies.
Main Results:
- No universal definition of treatment resistance exists; controlled trials are scarce.
- Open-label studies suggest efficacy of mycophenolate mofetil, calcineurin inhibitors, leflunomide, IVIg, immunoadsorption, and rituximab for refractory proliferative lupus nephritis.
- Initial treatment for membranous lupus nephritis is effective in two-thirds of patients; more aggressive regimens are for refractory cases, with conflicting evidence for MMF.
Conclusions:
- Treatment of refractory lupus nephritis currently lacks robust evidence and is largely anecdotal.
- Development of validated international consensus criteria for renal response is crucial.
- Standardized criteria will enable well-designed controlled trials to compare treatment modalities.
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