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Updated: Oct 3, 2025
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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
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Expert Perspective: An Approach to Refractory Lupus Nephritis
1Allegheny Health Network, Pittsburgh, Pennsylvania.
Arthritis & Rheumatology (Hoboken, N.J.)
|February 15, 2022
Summary
Refractory lupus nephritis (LN) occurs when standard treatments fail. Alternative therapies like B cell-targeted therapy (rituximab) are options, but limited evidence exists for rescue treatments after rituximab failure.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) frequently impacts the kidneys, manifesting as lupus nephritis (LN).
- A significant portion of LN patients exhibit resistance to standard immunosuppressive therapies, termed refractory LN.
- Factors beyond drug resistance, including adherence and genetic predispositions, influence treatment response.
Purpose of the Study:
- To define refractory lupus nephritis (LN).
- To outline the current treatment pathway for refractory LN, including B cell-targeted therapy (rituximab).
- To identify potential alternative rescue therapies for patients unresponsive to rituximab.
Main Methods:
- Defining refractory LN based on proteinuria and estimated glomerular filtration rate (eGFR) changes after standard induction regimens.
- Reviewing current clinical practices for refractory LN management.
- Summarizing existing literature on alternative therapies post-rituximab failure.
Main Results:
- Refractory LN is characterized by a lack of improvement or worsening of proteinuria/eGFR despite two standard induction regimens.
- Rituximab is a common next-line therapy for refractory LN.
- Limited evidence exists for alternative rescue therapies following rituximab non-response.
Conclusions:
- Accurate definition and identification of refractory LN are crucial for guiding treatment decisions.
- While rituximab is a key therapy, further research is needed to establish effective rescue strategies for non-responders.
- Exploring novel therapeutic avenues is essential for improving outcomes in refractory lupus nephritis.
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