Lupus Nephritis and Chronic Kidney Disease: A Scoping Review

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• End-stage kidney disease (ESKD) prevention is a primary goal for lupus nephritis (LN) patients.
• Chronic kidney disease (CKD) is prevalent in LN, yet data on its risk factors is limited, with recent research focusing on acute LN treatments.

Purpose of the Study:

• To conduct a scoping review summarizing the prevalence and risk factors for CKD in lupus nephritis (LN) patients.
• To consolidate 'real-world' data on CKD and its progression in systemic lupus erythematosus (SLE) and LN cohorts.

Main Methods:

• Systematic search of PubMed and Web of Science databases for longitudinal cohorts reporting CKD outcomes and risk factors in SLE and LN.
• Inclusion of fifteen studies that met the search criteria for 'real-world' data analysis.

Main Results:

• CKD prevalence varied widely, from under 10% to nearly 50% across different LN and SLE cohorts.
• Identified risk factors for CKD progression include initial renal impairment, poor 1-year post-treatment renal function, delayed diagnosis, biopsy findings, inadequate treatment response, nephritic flares, hypertension, and persistent proteinuria.
• Many identified risk factors are potentially modifiable through therapeutic interventions.

Conclusions:

• CKD significantly impacts morbidity, mortality, quality of life, and treatment choices in LN patients.
• Effective management requires both immunomodulatory therapies for disease control and non-immune strategies for renoprotection and CKD complication prevention.
• Addressing identified risk factors is essential to reduce the lifetime risk of ESKD in lupus nephritis patients.