Lupus nephritis

Lupus nephritis (LN) is one of the common manifestations of systemic lupus erythematosus. Kidney biopsy remains a mainstay of LN diagnosis, which is usually prompted by abnormal urinary sediment, proteinuria, or elevated creatinine. New International Society of Nephrology/Renal Pathology Society classification of LN tends to remove some of the ambiguities of World Health Organization classification and results in better categorization of patients. Although prognosis of LN has improved with the combined use of cytotoxic and steroid therapy, up to 20% of these patients progress to renal failure. Moreover, toxicity of the current regimens remains a major concern. Last few decades have seen a tremendous progress being made in understanding the pathogenesis of LN, but a little has been added to armamentarium against LN, leaving physicians with a few choices. Fortunately, with unfolding of molecular processes involved in disease pathogenesis, new targets for drug therapy have emerged. Whether these medications will prove to be more efficacious and less toxic remains a matter of debate and will be answered by several ongoing trials and future studies.