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Update on Lupus Nephritis: Core Curriculum 2020.
Samir V Parikh1, Salem Almaani1, Sergey Brodsky1
1The Ohio State University Wexner Medical Center, Columbus, OH.
Summary
Lupus nephritis (LN) is a major kidney complication of systemic lupus erythematosus, with limited treatment advances. This review covers LN epidemiology, pathogenesis, diagnosis, and treatment, highlighting areas for improved kidney health outcomes.
Area of Science:
- Nephrology
- Immunology
- Autoimmune Diseases
Background:
- Systemic lupus erythematosus (SLE) frequently impacts the kidneys, leading to lupus nephritis (LN).
- LN is a primary cause of kidney injury in SLE patients, significantly increasing morbidity and mortality.
- The heterogeneous pathophysiology of LN involves genetic and environmental factors.
Purpose of the Study:
- To provide an updated review of lupus nephritis (LN).
- To cover current understanding of LN epidemiology, pathogenesis, diagnosis, and treatment.
- To discuss challenging issues in LN management and identify areas for improvement.
Main Methods:
- Review of current literature on lupus nephritis.
- Synthesis of established approaches to LN care.
- Identification of knowledge gaps and future research directions.
Main Results:
- Despite advances in understanding LN pathogenesis, effective treatments remain limited.
- Kidney failure risk in LN patients is unacceptably high.
- Current management strategies require refinement to improve long-term kidney health.
Conclusions:
- Further research is needed to address deficiencies in LN diagnosis and treatment.
- Optimizing management of LN during pregnancy and timing of transplantation are critical.
- Evolving role of corticosteroids and novel therapeutic strategies are essential for better patient outcomes.
Keywords:
Lupus nephritis (LN)complete response (CR)corticosteroidscyclophosphamideend-stage kidney disease (ESKD)glomerulonephritis (GN)histopathologic classificationinduction therapykidney biopsylupusmaintenance therapymycophenolate mofetil (MMF)partial response (PR)pregnancyproteinuriareviewrituximabsystemic lupus erythematosus (SLE)