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Lupus Nephritis, New Treatment Guidelines

Lupus nephritis

Lupus nephritis is a serious complication of systemic lupus erythematosus (SLE), often referred to simply as lupus, and proper treatment is critical to prevent kidney failure. The American College of Rheumatology (ACR) has now issued new treatment guidelines for lupus nephritis, including information for pregnant women with SLE and kidney involvement.

Lupus nephritis is a serious complication

Lupus nephritis is an inflammation of the kidney caused by SLE, an autoimmune disease in which the immune system attacks healthy cells and tissues, and in some patients with SLE, that includes the kidneys. Lupus nephritis affects an estimated 3 out of every 10,000 people and can lead to kidney failure.

Individuals who develop lupus nephritis typically experience weight gain, dark urine, high blood pressure, and swelling around the ankles, fingers, legs, and eyes. To make an accurate diagnosis, physicians typically conduct urine and blood tests, as well as do a kidney biopsy to confirm the diagnosis and determine how far the disease has spread.

According to Dr. Bevra Hahn, professor of medicine at the University of California, Los Angeles, and one of the contributors to the new guidelines, “Lupus nephritis can be life-threatening, and proper management of the disease is vital to prevent permanent organ damage and preserve quality of life for patients.”

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Lupus nephritis affects more than one-third (35%) of US adults with SLE at diagnosis, and that percentage climbs to 60% within the first ten years of getting an SLE diagnosis. The survival rate for individuals with lupus nephritis after a decade of SLE is 88%, and the rate is lower for African Americans.

The new guidelines for lupus nephritis from the ACR were compiled after a thorough review of medical literature since 1966. In part they include the following:

  • Recommendation for kidney biopsy for previously untreated patients who have active lupus nephritis
  • Adjunctive treatment with ACE (angiotensin-converting enzyme) inhibitors, hydroxychloroquine, and control of blood pressure with a goal of 130/80 mmHg or lower for most SLE patients who have nephritis
  • Detecting vascular disease in patients with SLE and with kidney abnormalities
  • Treating nephritis in pregnant women. Active lupus nephritis can worsen the disease, and certain medications used to treat lupus nephritis may cause birth defects.
  • Maintaining improvement in patients who respond to induction therapy with azathioprine or mycophenolate mofetil, which are immunosuppressive drugs

Dr. Hahn noted that despite the development of new treatments for lupus nephritis, advancement to end-stage renal disease has increased over the past 20 years, especially among blacks, young patients, and individuals living in the southern United States.

Dr. Hahn concluded that “Ongoing evaluation and expansion of the guidelines is necessary to further improve outcomes for patients with SLE and nephritis.” The new treatment guidelines for lupus nephritis are a step in the right direction toward reducing the increase in renal failure, and individuals with the SLE complication should ask their doctor about them.

Bevra HH et al. American College of Rheumatology guidelines for screening, treatment and management of lupus nephritis. Arthritis Care & Research 2012 May 3 online. DOI:10.1002/acr.21664

Image: Wikimedia Commons