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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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Lupus nephritis: redefining the treatment goals
An S De Vriese1, Sanjeev Sethi2, Fernando C Fervenza3
1Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
Kidney International
|November 9, 2024
Summary
Accurate assessment of lupus nephritis activity is crucial for tailored therapy. This study proposes a dynamic approach focusing on clinical, immunologic, and kidney function remission to improve patient outcomes.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Proliferative lupus nephritis involves fluctuating disease activity and chronic immune dysregulation.
- Current assessment methods struggle to distinguish active inflammation from chronic damage, impacting therapy decisions.
Purpose of the Study:
- To discuss current tools for assessing lupus nephritis activity.
- To propose redefined, individualized treatment goals for lupus nephritis management.
Main Methods:
- Review of clinical, serologic, and histologic tools for disease activity assessment.
- Discussion of biomarkers for evaluating treatment response and disease progression.
Main Results:
- Traditional treatment goals (proteinuria, kidney function) do not fully capture disease activity.
- Histologic remission is critical, as clinical remission may mask persistent inflammation.
- Novel biomarkers are lacking, with anti-double-stranded DNA antibodies remaining key for serologic assessment.
Conclusions:
- Persistent immune dysregulation drives lupus nephritis activity and requires focused monitoring.
- A dynamic, individualized approach with simultaneous goals of clinical, immunologic, and kidney function remission is proposed.
- Biomarkers like proteinuria, hematuria, eGFR, complement levels, and anti-dsDNA antibodies are essential for achieving these goals.
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