[New concepts in the treatment of lupic nephropathy]

The therapeutic goals for a patient with newly diagnosed lupus nephritis should be to achieve a prompt renal remission, to avoid renal flares, to avoid chronic renal impairment, and to fulfil these objectives with minimal toxicity. An advance in the therapy of LN has been the introduction of concepts of induction of remission (by a sort course of vigorous immunosupression such as monthly intravenous cyclophosphamide) and maintenance of remission (by long-term administration of the same cytotoxic drug given less frequently or a potentially safer immunosupressant such as azathioprine). Mycophenolate mofetil may be an alternative to cyclophosphamide for induction and maintenance therapy of patients with proliferative LN. Optimal care of lupus nephritis patients should include non immunosuppressive measures such as the vigorous management of cardiovascular risk factors and the treatment of proteinuria.