Treatment of lupus nephritis.
Renal involvement in systemic lupus erythematosus (SLE) is a serious complication of the disease. However, the prognosis of patients with lupus nephritis is continually improving with 10-year survival rates now greater than 75%. This improvement reflects earlier diagnosis due to more sensitive and specific diagnostic tests, better clinical appreciation of the natural history, and improved treatment of SLE and its manifestations. This review of the treatment of lupus nephritis has graded the level of evidence of specific treatment using the guidelines of the US Preventive Service Task Force. Although many new treatments have been advocated, the best evidence for treating proliferative lupus nephritis relies on a strategy combining specific treatment of the SLE as well as generalised treatment of the associated comorbidities. This strategy involves a combination of corticosteroids and cytotoxic agents plus or minus the adjunctive use of antimalarials, coordinated aggressive management of hypertension, proteinuria, infections, dyslipidaemia, thrombotic coagulopathy and potential renal replacement therapies.
Hejaili
Fayez F
FF
Division of Nephrology, London Health Sciences Centre, Westminster Campus, The University of Western Ontario, Canada.
Moist
Louise M
LM
Clark
William F
WF
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy; D008181:Lupus Nephritis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*
D000305:Adrenal Cortex Hormones; D000962:Antimalarials; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents