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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
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Chronic kidney disease: the missing concept in the 2019 EULAR/ERA-EDTA recommendations for lupus nephritis

Jorge E Rojas-Rivera1,2, Sevcan A Bakkaloglu3,4, Davide Bolignano3,5

  • 1IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT, Madrid, Spain.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|July 11, 2023
PubMed

Insights

Lupus nephritis (LN) is a cause of chronic kidney disease (CKD). Current guidelines overlook CKD and albuminuria in LN management, despite high cardiovascular risk. Integrating LN into CKD frameworks is crucial for patient care.

Area of Science:

  • Nephrology
  • Rheumatology
  • Cardiology

Background:

  • Chronic kidney disease (CKD) is defined by decreased glomerular filtration rate (GFR) or elevated urinary albumin:creatinine ratio (UACR), indicating increased risk of adverse outcomes, including cardiovascular mortality.
  • Lupus nephritis (LN) is a significant cause of CKD, yet current management guidelines from EULAR/ERA-EDTA and EULAR do not adequately address albuminuria or CKD in LN patients.
  • This oversight is critical as patients with severe CKD and high cardiovascular risk, often seen in LN, could benefit from established cardiovascular disease prevention strategies.

Purpose of the Study:

  • To advocate for a paradigm shift in managing lupus nephritis (LN).
  • To integrate LN into the broader understanding of chronic kidney disease (CKD).
  • To ensure that evidence from large CKD trials is applied to LN management.

Main Methods:

  • Review of current European League Against Rheumatism (EULAR) and European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) recommendations for LN and cardiovascular risk management.
  • Analysis of diagnostic criteria for CKD, including GFR and UACR thresholds.
  • Comparison with existing guidelines for cardiovascular disease prevention.

Main Results:

  • Current LN management guidelines lack specific focus on albuminuria and CKD.
  • Proteinuria targets in LN recommendations may not align with the needs of patients with severe CKD and high cardiovascular risk.
  • Existing cardiovascular disease prevention guidelines may be underutilized in LN management.

Conclusions:

  • LN should be conceptualized as a cause of CKD, not a separate entity.
  • Recommendations for LN management should incorporate CKD principles and evidence from large CKD trials.
  • Adopting an integrated approach will improve cardiovascular risk management for patients with LN.

Keywords:
albuminuriacardiovascular diseasecardiovascular riskchronic kidney diseaseglomerular filtration ratelupus nephritissystemic lupus erythematoustreatment

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