Pharmacotherapy of lupus nephritis: time for a consensus?

The optimal therapy for lupus nephritis has been the subject of considerable debate.

To provide evidence- and expert-based recommendations.

To review the literature and the European League Against Rheumatism recommendations.

Risk stratification based on histological, demographical, clinical and laboratory characteristics allows the identification of patients at high risk for loss of renal function, and thus more likely to benefit from more aggressive therapy. Achieving remission within the first months of treatment, irrespective of the agent used, correlates with good long-term renal outcomes; maintenance of remission can be achieved with less toxic therapies. Aggressive management of atherosclerosis risk factors and renoprotective therapy for those patients with chronic renal disease improve long-term survival and prognosis.