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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
Induction and maintenance therapy in proliferative lupus nephritis
Claudio Ponticelli1, Richard J Glassock, Gabriella Moroni
1Department of Nephrology, IRCCS Istituto Humanitas, Milan, Italy. claudio.ponticelli@fastwebnet.it
Journal of Nephrology
|January 22, 2010
Summary
Newer treatments for proliferative lupus nephritis (PLN) reduce steroid dosage and avoid prolonged cyclophosphamide use. These strategies improve patient quality of life and survival rates.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Proliferative lupus nephritis (PLN) requires induction and maintenance therapy.
- Current induction options include cyclophosphamide/steroids, methylprednisolone/cyclophosphamide, or mycophenolate mofetil/prednisone.
- Rituximab is an option for refractory cases, often with other agents.
Purpose of the Study:
- To review modern immunosuppressive strategies for proliferative lupus nephritis.
- To highlight newer treatments that may offer improved tolerability and outcomes.
Main Methods:
- Review of current treatment options for PLN induction and maintenance.
- Comparison of efficacy and adverse event profiles of different immunosuppressive agents.
- Discussion of steroid-sparing and cyclophosphamide-avoiding strategies.
Main Results:
- Intravenous cyclophosphamide with steroids is effective but has severe adverse events.
- Methylprednisolone or mycophenolate mofetil-based regimens show comparable efficacy with better tolerability.
- Maintenance therapy with azathioprine or mycophenolate mofetil can be as effective as cyclophosphamide.
- Cyclosporine offers benefits in patients with persistent proteinuria, allowing for steroid-sparing.
Conclusions:
- Modern immunosuppression allows for reduced steroid dosage and avoidance of prolonged cyclophosphamide.
- Newer strategies may lead to fewer adverse effects, improved quality of life, and better survival in PLN patients.
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