Recent Advances in Treatment Strategies for Lupus Nephritis

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune chronic inflammatory disease that affects multiple organs and tissues. Lupus nephritis (LN) is a serious complication of SLE, which occurs at a high rate. Conventional treatment strategies of LN have been widely accepted by two concepts such as induction therapy and maintenance therapy. In LN induction therapy until recently, cyclophosphamide in combination with prednisone (PSL) has been the standard method of treatment for proliferative forms of LN. In the latest review, the combination of mycophenolate mofetil (MMF) is also considered a standard treatment option. Furthermore, a multi-target therapy with tacrolimus (Tac) added to PSL and MMF, with reference to a regimen after organ transplantation has also been reported. In LN maintenance therapy, although recent reports have demonstrated that MMF, azathioprine, and Tac in combination with PSL may prevent renal flares, there is no definite opinion in the period of use or the method of tapering. On the contrary, there are also concepts of two mechanisms of therapy for LN, such as a treatment based on the immunological mechanism as an autoimmune disease and a treatment based on the non-immunological mechanism as a chronic kidney disease. Nephrologists need to continue searching for the best-mix treatment regimen according to various clinical findings. We review the options available for the treatment of LN, and summarize the results of recently published clinical trials that add new perspectives to the management of kidney disease in SLE.

Autoimmune Disease-Associated Hypertension

“…The depletion of B cells with anti-CD20 antibodies (the mouse equivalent of rituximab) [60] and mycophenolate mofetil (MMF) [11] attenuated hypertension in this mouse model. Importantly, both rituximab and MMF are used clinically in human patients with SLE [61, 62] and MMF has been shown to reduce blood pressure in small clinical studies in humans [63]. A more recent study from our laboratory addressed the question of whether autoantibodies mechanistically contribute to the pathogenesis of hypertension during autoimmune disease.…”

Regulating T Cell Population Alleviates SLE by Inhibiting mTORC1/C2 in MRL/lpr Mice

“…Complement is implicated in the pathogenesis of SLE, and C3c, a marker of intra glomerular complement activation in MRL/lpr mice, is deposited in the kidney during lupus nephritis (Karasawa et al, 2018). Our results showed that INK128 significantly reduced the deposition of complement factor C3c, but rapamycin showed slight effects in kidney (Figure 1F).…”

Treatment of Lupus Nephritis from Iranian Traditional Medicine and Modern Medicine Points of View: A Comparative Study

“…However, in the early stages of LN including class I and II, no therapy is recommended by the American College of Rheumatology (ACR) guideline. The European LeagueAgainst Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) suggested low to moderate doses of oral steroid agents which cause moderate proteinuria and glomerular hematuria [ 18 , 41 , 46 , 47 ]. It should be noted that 5–20% patients with LN even with immunosuppressive therapy develop ESRD within 10 years [ 43 ].…”