Lupus nephritis: a modern treatment paradigm

Lupus nephritis is the most common and life-threate­ning manifestation of systemic lupus erythematosus (SLE) and continues to cause a high percentage of terminal renal failure. The modern treatment of lupus nephritis, as well as new therapeutic strategies, is described in this review. Diagnosis of kidney damage in SLE (lupus nephritis), according to the recommendations of ACR, is based on the following criteria: clinical and laboratory manifestations in the form of proteinuria > 0.5 g/day (or more than 3 “+” when using test strips) and/or the presence of cellular clusters, including clusters of erythrocytes and cylinders (hemoglobin, granular, tubular or mixed). Additional criteria are the results of histological examination of the kidney biopsy with confirmation of the presence of immune complex kidneys damage characteristic of lupus nephritis. The ma­nagement of lupus nephritis patients consists of two successive phases: initial (induction) and supporting, when combinations of glucocorticoids and immunosuppressors are used. During the induction phase, intensive treatment with glucocorticoids in combination with other immunosuppressants is carried out to rapidly suppress the immune complex renal inflammation and to stop the development of their damage. The aim of this approach and the main task of induction therapy are the restoration of renal function and induction of remission by monitoring the immunological activity of the process. Supporti­ve therapy is used to fix remission and to prevent exacerbations by using drugs or treatment regimens with less risk of complications. Despite the disappointing results of several recent stu­dies, new methods of treatment aimed at various immunological pathways are being actively studied in lupus nephritis. The most promising direction is therapy aimed at B-cells. Deepening understanding of the pathogenesis of lupus nephritis, deve­loping new treatments and optimizing the design of clinical trials will ensure the successful development and introduction of new drugs for lupus.