Preventing renal failure in patients with severe lupus nephritis

Abstract

Advances in immunosuppressive treatment regimens, with increased efficacy, while minimizing the treatment-related toxicities, and better prevention and treatment of complications, have resulted in improved patient and renal survival in subjects with severe proliferative lupus nephritis over the past few decades. This review discusses the issues that are pertinent to the preservation of renal function in these patients. Treatment of severe proliferative lupus nephritis can be divided into an initial phase of induction followed by a prolonged maintenance phase, both of which impact upon the long-term renal and patient survival. The immunosuppressive potency of the treatment required for disease control varies according to the disease activity during the different phases. Despite variations in the choice, duration, and route of administration of antiproliferative agents, data to date suggest that immunosuppressive treatments combining cyclophosphamide or mycophenolate mofetil with corticosteroid appear to have similar efficacy in terms of inducing immunologic remission. In this regard, the immunologic efficacy of treatment is prerequisite to the prevention of irreversible loss of nephrons, but long-term renal outcome is also dependent on factors other than treatment efficacy, such as preexisting renal parenchymal damage and blood pressure control. Prompt diagnosis, early effective therapy, and reducing the risk of relapses are the disease specific measures that are essential to long-term renal preservation and the prevention of renal failure in subjects with severe proliferative lupus nephritis.