[Lupusnephritis]

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Context:

• Systemic lupus erythematosus (SLE) frequently presents with renal manifestations, significantly impacting patient morbidity and mortality.
• Histological classification of lupus nephritis dictates specific therapeutic strategies.
• Current treatment paradigms range from immunosuppression to targeted therapies based on disease class.

Purpose:

• To outline the different histological classes of lupus nephritis and their associated treatment protocols.
• To discuss emerging therapeutic approaches, including B-cell depletion and cytokine inhibition.
• To highlight the recent approval of belimumab, a B-lymphocyte-stimulating factor inhibitor, for SLE treatment.

Summary:

• Lupus nephritis exhibits six histological classes, each requiring distinct management.
• Class II (mesangial proliferative) nephritis treatment focuses on extrarenal manifestations.
• Class III/IV (proliferative) nephritis necessitates cyclophosphamide or mycophenolate mofetil (MMF).
• Class V (membranous) nephritis benefits from dual renin-angiotensin aldosterone (RAAS) blockade.
• Class I and VI nephritis do not require immunosuppressive therapy.
• Novel treatments involve B-cell depletion and cytokine inhibition.
• Belimumab, a monoclonal antibody targeting B-lymphocyte-stimulating factor (Blys), is a new approved therapy for SLE.

Impact:

• Provides a comprehensive overview of lupus nephritis classification and treatment.
• Highlights the evolving landscape of SLE therapeutics with new targeted agents.
• Emphasizes the importance of histological diagnosis for guiding patient management and improving outcomes.