A Review of Lupus Nephritis

Abstract

Background Lupus nephritis (LN) is one of the most common severe organ manifestations of systemic lupus erythematosus (SLE). LN is associated with significant morbidity and mortality in SLE patients, as up to 20% of patients progress to end-stage renal disease (ESRD). The clinical manifestations of LN are variable, ranging from asymptomatic proteinuria to a myriad of manifestations associated with nephritic and nephrotic syndromes and ESRD. It is therefore important to screen all SLE patients for LN. Content Urinalysis is a useful screening test in LN. Quantification of proteinuria can be performed with either a urine protein-to-creatinine ratio or 24-h urine sample collection for protein. Renal biopsy remains the gold standard for diagnosis of LN. Traditional serum biomarkers used to monitor SLE and LN disease activity and flares include anti–double-stranded DNA antibodies and complement components 3 and 4. Other nonconventional biomarkers found to correlate with LN include anti-C1q and surrogate markers of type 1 interferon regulatory genes (INF gene signature). Potential urinary biomarkers for LN include monocyte chemoattractant protein 1, neutrophil gelatinase-associated lipocalin, tumor necrosis factor-like inducer of apoptosis, and vascular cell adhesion molecule 1. Summary Although studies have shown promising results for the use of alternative biomarkers, these require validation in prospective studies to support their use. Renal remission rates in patients receiving standard of care therapy for induction and maintenance treatment of LN remain low. This has prompted further research in newer therapeutic targets in LN ,which have shown promising results.

The Role of N6-Methyladenosine in Inflammatory Diseases

“…Systemic lupus erythematosus (SLE) is a typical multisystem inflammatory autoimmune disease [69]. Normally, lupus nephritis (LN) is one of the most common severe organ manifestations of SLE, which is related to high mortality [70]. Neuropsychiatric lupus (NPSLE) occurs in 40-90% of SLE patients, and the damage of microglia may be the major damaged cell [71][72][73].…”

Complement C4d as a biomarker for systemic lupus erythematosus and lupus nephritis

“…To date, a renal biopsy is still the gold standard for the diagnosis of LN and assessment of disease severity, but this intrusive procedure causes patient trauma and is inappropriate for long-term serial monitoring. 4 Additionally, although numerous researchers have identified many predictive biomarkers of SLE and LN, their utility in future clinical practice has been hampered by various limitations. 5 Complement split product C4d-positive staining along peritubular capillaries (PTC) on renal allograft biopsy specimens was introduced as one of the diagnostic criteria for antibody-mediated rejection (AMR) in the late 1990s.…”

“…To date, a renal biopsy is still the gold standard for the diagnosis of LN and assessment of disease severity, but this intrusive procedure causes patient trauma and is inappropriate for long-term serial monitoring. 4 Additionally, although numerous researchers have identified many predictive biomarkers of SLE and LN, their utility in future clinical practice has been hampered by various limitations. 5…”

Noninvasive Evaluation of Lupus Nephritis Activity Using a Radiomics Machine Learning Model Based on Ultrasound

“… 3 The goal of LN treatment is to eliminate active inflammation and achieve renal remission and disease quiescence. 4 Currently, renal biopsy is the gold standard for diagnosis and treatment of LN. 5 It is also the only way to judge disease activity.…”