Klassifikation der Lupusnephritis

Abstract

Kidney involvement in systemic lupus erythematosus (SLE), so-called lupus nephritis (LN), is very common with an incidence of approximately 40–60%, often also represents the first organ manifestation of SLE or frequently occurs in the first 5–10 years after diagnosis of SLE. An LN can be manifested as almost all forms of glomerulonephritis and various tubulointerstitial and vascular complications and is therefore also called the chameleon of kidney pathology. In 2021 a new revision and modification of the LN classification was undertaken based on the experience of the last 15 years, which resulted in several changes relevant for the practice. Among these are more precise and overall improved definitions and classifications of glomerular lesions and the introduction of a new National Institutes of Health (NIH) activity and chronicity index to be applied to all classes. Histological confirmation of the LN and thus the LN class present is a relevant component of adequate treatment planning in patients with SLE and LN. Early diagnosis and rapid response to treatment, in particular, are of prognostic importance for the preservation of kidney function. Thus, the focus of treatment is to achieve complete remission and to avoid active disease phases. Recent insights into the pathomechanisms of SLE and LN have led to the development of targeted treatment, which will increasingly expand the therapeutic spectrum for patients with SLE and LN. For LN, the time point at which treatment changes seem to be necessary or useful cannot be optimally assessed on the basis of clinical and laboratory parameters. Studies evaluating the timing and frequency of repeat biopsies are expected to provide insights in the future.