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Updated: Sep 8, 2025
09:43
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: Unmet Needs and Evolving Solutions.
Matteo Abinti1,2, Marc Patricio-Liebana3,4, Hans-Joachim Anders5
1Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Clinical Journal of the American Society of Nephrology : CJASN
|August 11, 2025
Summary
Lupus nephritis (LN) management needs better distinction between active inflammation and irreversible kidney damage. Novel immunotherapies, like complement inhibition and clone-directed treatments, offer promise for improved outcomes and reduced toxicity.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Lupus nephritis (LN) presents significant unmet needs despite advancing immunotherapies.
- Distinguishing active immunological injury from irreversible kidney damage is crucial for effective treatment.
- Residual proteinuria requires careful interpretation to differentiate disease activity from hyperfiltration.
Purpose of the Study:
- To discuss strategies for differentiating immunological activity from irreversible kidney injury in lupus nephritis.
- To explore novel therapeutic approaches, including complement inhibition and clone-directed therapies.
- To advocate for conceptual and management improvements in lupus nephritis care.
Main Methods:
- Review of histological signs of immunological activity versus irreversible kidney injury.
- Discussion on interpreting residual proteinuria via repeat biopsy.
- Conceptualization of clone-directed therapy targeting autoreactive B and T cells and plasma cells.
Main Results:
- Per-protocol biopsies show irreversible injury even with modern triple immunotherapy.
- Immediate complement system inhibition may address unmet needs and potentially replace early glucocorticoid therapy.
- Availability of B cell- and plasma cell-targeting therapies offers parenteral administration, avoiding oral non-adherence.
Conclusions:
- Differentiating active inflammation from chronic damage is key in lupus nephritis.
- Targeting autoreactive clones and long-lived plasma cells offers a promising therapeutic strategy.
- Orphan disease designation for LN could accelerate progress towards managing this complex autoimmune condition.
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