title: The pathogenesis, diagnosis and treatment of lupus nephritis.
abstract: OBJECTIVE
  Renal involvement is a major cause of morbidity and mortality in systemic lupus erythematosus. In this review, we provide an update on recent discoveries in the pathogenesis, diagnosis, and treatment of lupus nephritis.
  
  
  RESULTS
  Localized long-lived plasma cells have been identified as playing an important role in lupus nephritis. In addition, the roles of aberrant expression of microRNAs and proinflammatory cytokines have been explored. Early diagnosis is important for effective treatment and multiple biomarkers have been identified; however, none has been yet validated for clinical use. Biomarker panels may turn out to be more accurate than each individual component. Biologic agents for the treatment of lupus nephritis are being studied, including belimumab which was recently approved for nonrenal systemic lupus erythematosus. Rituximab has not proven itself in large, placebo-controlled trials, although it is still being used in refractory cases of lupus nephritis.
  
  
  CONCLUSIONS
  Lupus nephritis is a potentially devastating complication of systemic lupus erythematosus. Immune cells, cytokines, and epigenetic factors have all been recently implicated in lupus nephritis pathogenesis. These recent discoveries may enable a paradigm shift in the treatment of this complex disease, allowing the tailoring of treatment to target specific pathogenic mediators at specific points in time in the progression of disease.
authors.affiliation: aDepartment of Medicine, Montefiore Medical Center bPediatric Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine cDivision of Rheumatology, Department of Medicine dDepartment of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA *Noa Schwartz and Beatrice Goilav contributed equally to the writing of this article.
authors.forename: Noa
authors.initials: N
authors.lastname: Schwartz
authors.forename: Beatrice
authors.initials: B
authors.lastname: Goilav
authors.forename: Chaim
authors.initials: C
authors.lastname: Putterman
mesh_terms: D000818:Animals; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001323:Autoantibodies / Q000096:biosynthesis; D001402:B-Lymphocytes / Q000276:immunology; D016207:Cytokines / Q000378:metabolism; D006801:Humans; D007165:Immunosuppression Therapy; D008181:Lupus Nephritis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008264:Macrophages / Q000276:immunology; D051379:Mice; D035683:MicroRNAs / Q000235:genetics / Q000378:metabolism; D010950:Plasma Cells / Q000276:immunology; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D016207:Cytokines; D035683:MicroRNAs; D000069283:Rituximab