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Lupus nephropathy beyond immunosuppression: Searching for nephro and cardioprotection

Enrique Morales1,2,3, Justo Sandino1,2, María Galindo2,3,4

  • 1Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.

Frontiers in Nephrology
|September 7, 2023
PubMed

Insights

Systemic lupus erythematosus (SLE) can cause kidney damage, leading to end-stage kidney disease (ESKD). This review explores therapies beyond immunosuppression to protect kidneys and the heart in lupus nephritis (LN).

Area of Science:

  • Nephrology
  • Rheumatology
  • Pharmacology

Background:

  • Renal involvement, or lupus nephritis (LN), is a common complication of systemic lupus erythematosus (SLE), frequently progressing to end-stage kidney disease (ESKD).
  • While immunosuppressive therapies are established for LN, their role in preventing chronic kidney disease (CKD) progression is well-documented.
  • Emerging evidence highlights the importance of nephroprotective and cardioprotective strategies alongside immunosuppression for patients with proteinuric CKD in LN.

Purpose of the Study:

  • To review pharmacological options for cardiovascular and renal protection in lupus nephritis (LN).
  • To explore therapeutic measures beyond standard immunosuppression and renin-angiotensin-aldosterone system (RAAS) blockade for improved renal prognosis in LN.
  • To address the scarcity of literature on specific nephro- and cardioprotective strategies in the context of LN management.

Main Methods:

  • Literature review of pharmacological options for cardiovascular and renal protection.
  • Focus on therapies relevant to patients with proteinuric chronic kidney disease (CKD) in lupus nephritis (LN).
  • Exploration of treatments outside of conventional immunosuppressive regimens and RAAS blockade.

Main Results:

  • Immunosuppressive therapy is effective in preventing chronic kidney disease (CKD) in lupus nephritis (LN).
  • Additional nephro- and cardioprotective measures are crucial for managing cardiovascular risk factors and proteinuria.
  • The literature on specific protective measures beyond RAAS blockade in LN is limited.

Conclusions:

  • Optimal management of lupus nephritis (LN) requires a combination of immunosuppression and targeted nephro- and cardioprotective strategies.
  • Controlling cardiovascular risk factors and proteinuria is essential for improving renal outcomes in LN patients.
  • Further research is needed to elucidate the role of various pharmacological options in enhancing renal and cardiovascular protection in LN.
Keywords:
Isglt2RAAS blockadediureticslupus nephritisproteinuria

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