Lupus nephritis: A critical review

Andrea T. Borchers, Naama Leibushor, Stanley M Naguwa, Gurtej S. Cheema, Yehuda Shoenfeld, M. Eric Gershwin

Research output: Contribution to journalArticle

146 Scopus citations

Abstract

Lupus nephritis remains one of the most severe manifestations of systemic lupus erythematosus associated with considerable morbidity and mortality. A better understanding of the pathogenesis of lupus nephritis is an important step in identifying more targeted and less toxic therapeutic approaches. Substantial research has helped define the pathogenetic mechanisms of renal manifestations and, in particular, the complex role of type I interferons is increasingly recognized; new insights have been gained into the contribution of immune complexes containing endogenous RNA and DNA in triggering the production of type I interferons by dendritic cells via activation of endosomal toll-like receptors. At the same time, there have been considerable advances in the treatment of lupus nephritis. Corticosteroids have long been the cornerstone of therapy, and the addition of cyclophosphamide has contributed to renal function preservation in patients with severe proliferative glomerulonephritis, though at the cost of serious adverse events. More recently, in an effort to minimize drug toxicity and achieve equal effectiveness, other immunosuppressive agents, including mycophenolate mofetil, have been introduced. Herein, we provide a detailed review of the trials that established the equivalency of these agents in the induction and/or maintenance therapy of lupus nephritis, culminating in the recent publication of new treatment guidelines by the American College of Rheumatology. Although newer biologics have been approved and continue to be a focus of research, they have, for the most part, been relatively disappointing compared to the effectiveness of biologics in other autoimmune diseases. Early diagnosis and treatment are essential for renal preservation.

Original languageEnglish (US)
Pages (from-to)174-194
Number of pages21
JournalAutoimmunity Reviews
Volume12
Issue number2
DOIs
StatePublished - Dec 2012

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Keywords

  • Autoantibodies
  • Immune complexes
  • Interferons
  • Tolerance

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

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