[Lupus nephropathy: difficulties in its treatment]

The management of the patient with lupus nephropathy is still difficult. A new classification considering activity and chronicity indexes has revalued the histologic assessment as a prognostic and therapeutic guide. The benefits of immunosuppressive drugs in preventing progression of renal disease have been clarified and adverse effects reduced by new methods of administration. A key aspect of therapy is still individual selection of type and intensity of immunosuppression, that must be adjusted to the changing nature of the disease. Therapy must be balanced between optimal levels of efficacy and minimal toxicity.