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Lupus nephritis.

Ioannis Parodis1,2,3, Brad H Rovin4, Maria G Tektonidou5

  • 1Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. ioannis.parodis@ki.se.

Nature Reviews. Disease Primers
|September 25, 2025
PubMed
Summary
This summary is machine-generated.

Lupus nephritis (LN), a severe kidney complication of systemic lupus erythematosus (SLE), impacts many patients. Early recognition and multidisciplinary care are vital for managing this condition and preventing kidney failure.

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Area of Science:

  • Nephrology
  • Immunology
  • Rheumatology

Background:

  • Lupus nephritis (LN) is a serious kidney complication of systemic lupus erythematosus (SLE), affecting 25-60% of patients.
  • LN often manifests within 5 years of SLE diagnosis but can occur later, necessitating ongoing vigilance.
  • Despite advances, LN remains a significant cause of morbidity and mortality, potentially leading to irreversible kidney failure.

Purpose of the Study:

  • To review the current understanding of lupus nephritis (LN) pathogenesis, clinical presentation, and management strategies.
  • To emphasize the importance of early diagnosis and multidisciplinary care in improving outcomes for patients with SLE-related kidney disease.

Main Methods:

  • Review of existing literature on lupus nephritis (LN) pathogenesis, risk factors, and treatment modalities.
  • Analysis of current treatment paradigms, including pharmacotherapy and supportive care.

Main Results:

  • Key pathogenic pathways in LN include type I interferon signaling, calcineurin activation, and B/T cell dysfunction.
  • Risk factors for kidney failure progression include persistent proteinuria, low GFR, hypertension, and frequent flares.
  • Treatment is shifting towards multi-agent regimens and comprehensive, multidisciplinary care.

Conclusions:

  • Lupus nephritis (LN) requires a holistic management approach combining pharmacotherapy with tailored, multidisciplinary care.
  • Addressing both immune and non-immune factors is crucial for preserving kidney function and improving long-term outcomes in LN patients.