Systemic lupus erythematosus

Systemic lupus erythematosus

The principal goal of therapy in lupus nephritis is to normalize renal function or, at least, to prevent the progressive loss of renal function. Therapy differs depending on the pathologic lesion.[19, 35] It is important to treat extrarenal manifestations and other variables that may affect the kidneys.

Systemic lupus erythematosus (SLE), an autoimmune disease, is truly a disease of symptoms. Its attacks on the body’s immune system can affect everything from the skin and joints to internal organs, like the kidneys. When lupus affects the kidneys, it is called lupus nephritis (LN).

Corticosteroid therapy should be instituted if the patient has clinically significant renal disease. Use immunosuppressive agents, particularly cyclophosphamide, azathioprine, or mycophenolate mofetil, if the patient has aggressive proliferative renal lesions, as they improve the renal outcome. They can also be used if the patient has an inadequate response or excessive sensitivity to corticosteroids.[35, 36, 37]

Treat hypertension aggressively. On the basis of beneficial effects in other nephropathies, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been routinely used to treat proteinuria in lupus nephritis.

Alter the diet according to the presence of hypertension, hyperlipidemia, and renal insufficiency. Restrict fat intake or use lipid-lowering therapy such as statins for hyperlipidemia secondary to nephrotic syndrome. Restrict protein intake if renal function is significantly impaired.

Administer calcium supplementation to prevent osteoporosis if the patient is on long-term corticosteroid therapy, and consider adding a bisphosphonate (depending on renal function).

Avoid drugs that affect renal function, including nonsteroidal anti-inflammatory drugs (NSAIDs), especially in patients with elevated creatinine levels. Nonacetylated salicylates can be used to safely treat inflammatory symptoms in patients with renal disease.

Patients with active lupus nephritis should avoid pregnancy, because it may worsen their renal disease and because certain medications used in the treatment may be teratogenic.[38, 39, 40]

Patients with end-stage renal disease (ESRD), sclerosis, and a high chronicity index based on renal biopsy findings are unlikely to respond to aggressive therapy. In these cases, focus therapy on extrarenal manifestations of systemic lupus erythematosus (SLE) and on possible kidney transplantation.

People who have lupus and associated glomerular damage have lupus glomerulonephritis (LGN). There are several types of lupus glomeruloneprhitis that vary in their severity and are detected by biopsy. LGN occurs when antibodies and complement proteins build up in the kidneys and cause inflammation. Biopsy of the kidney is used to identify the type of LGN, which helps predict the expected course of kidney problems. LGN is divided into six different types based on the biopsy.

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