Refractory lupus nephritis: current Understanding and emerging treatment strategies

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multifaceted immune dysregulation, which ultimately trigger irreversible damage of tissue and organ. Lupus nephritis (LN) is the most common and life-threatening organ involvement of SLE. Although the prognosis of LN has been dramatically improved with the application of standard-of-care (SoC) regimens, there is an enormous unmet need regarding the global management of refractory LN. Currently, there is no consensus on definition for refractory LN, making early identification and prompt management greatly challengeable. Meanwhile, low remission rate and kidney survival rate, as well as poor prognosis has been longstanding clinical dilemmas for refractory LN. Fortunately, novel treatment options beyond SoC are constantly expanding. To change existing treatment paradigm and pave the way for precise treatment of refractory LN, we summarize current understanding and future considerations of refractory SLE, primarily focusing on the definition, clinical and prognostic characteristics, and emerging treatment strategies.