Nephritis in systemic lupus erythematosus (natural history, treatment, and pathogenesis)

Nephritis in systemic lupus erythematosus is a prototype for immune complex mediated renal disease in man. The renal manifestations are pleomorphic in their expression. In the past 35 years, the natural history of the disease and its response to treatment have been related to the renal histology seen when the patient was initially studied. Patients with normal kidneys and those with membranous nephropathy have five-year survivals that are excellent and uninfluenced by treatment. Patients with mesangial disease may be a heterogeneous population--those with deposits doing comparatively worse; focal and diffuse proliferative nephritis carry a poorer prognosis. Extensive studies in the relatively homogeneous NZB/NZW F1 hybrid mouse have led to a better understanding of human lupus nephritis. Critical factors in getting a good response involve not only selection of the appropriate drug but also its mode of administration and timing in relation to the course of the disease. Intelligent must be based on an understanding of etiopathogenesis. Recent studies have cast some light on the role of the mediators of inflammation, e.g. platelets, fibrinolysis, and the modulating role of the reticuloendothelial system. Future studies must take these into account in the discovery and evaluation of a new forms of therapy.