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Lupus Nephritis: Current Treatment Paradigm and Unmet Needs

[ Vol. 13 , Issue. 2 ]

Author(s):

Steven P. Menez*, Basset El Essawy and Mohamed G. Atta   Pages 105 - 113 ( 9 )

Abstract:


Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder characterized by chronic inflammation, which can result in a multitude of systemic or organ-limited manifestations, including the skin, lungs, heart, and kidney. SLE nephritis is present in an average of 38% of patients at the time of diagnosis, and may occur as the initial presentation of disease with progression to End-Stage Renal Disease (ESRD) in roughly 10-20% of patients.

Methods: A review of the current literature was undertaken to investigate the evolution of treatment of SLE nephritis based on randomized trials and robust observational studies. We aimed to provide a timeline of the development of current induction and maintenance therapy, as well as the development of novel targeted therapies, all leading to current guidelines.

Results: Based on all available current data on standard of care therapies for SLE nephritis, there is at best a complete remission rate of 50-60%, and roughly 13-25% of patients experience periods of relapse during maintenance therapy for SLE nephritis. Therefore, the need for newer, targeted therapies has been the focus of many current, ongoing clinical trials.

Conclusion: Standard induction and maintenance therapies at present are anti-proliferative and nonspecific, that is, interfering with the process of autoantigen presentation and activation of autoreactive leukocytes. However, newer agents with specific T-cell, B-cell, or proteasome targets are currently being investigated.

Keywords:

Chronic kidney disease, clinical trials, End-Stage Renal Disease (ESRD), immunosuppression, kidney biopsy, systemic lupus erythematosus.

Affiliation:

Johns Hopkins Department of Medicine, Division of Nephrology, Baltimore, MD, Department of Medicine, Al-Azhar University, Nephrology Unit, Cairo, Johns Hopkins Department of Medicine, Division of Nephrology, Baltimore, MD

Graphical Abstract:



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