What is the management of Systemic Lupus Erythematosus (SLE) with Lupus nephritis?

From the Guidelines

Systemic Lupus Erythematosus (SLE) with Lupus Nephritis management involves a combination of immunosuppressive therapy and glucocorticoids to control disease activity and prevent organ damage.

Key Principles

• The goal of treatment is to achieve remission or low disease activity, prevent flares, and preserve kidney function 1.
• Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight 1.
• Glucocorticoids should be minimized to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn 1.

Immunomodulatory Agents

• Belimumab or voclosporin in combination with standard of care can be effective in treating lupus nephritis 1.
• Methotrexate, azathioprine, or mycophenolate can be used to expedite the tapering or discontinuation of glucocorticoids 1.

Lupus Nephritis Management

• The management of lupus nephritis involves an initial period of intense immunosuppressive therapy to control disease activity, followed by a longer period of less intensive therapy to consolidate response and prevent relapses 1.
• Kidney involvement in SLE is best managed by interdisciplinary care with shared patient-physician decisions, and vigilance for symptoms and signs suggestive of kidney involvement is crucial 1.

Renal Transplantation

• Patients with SLE are good candidates for renal transplantation when clinical and serological lupus activity is absent or at a low level for at least 3-6 months 1.
• Post-transplantation recurrent lupus nephritis is a rare cause of renal allograft loss 1.

From the Research

Management of Systemic Lupus Erythematosus (SLE) with Lupus Nephritis

The management of SLE with lupus nephritis involves a combination of immunosuppressive drugs, glucocorticoids, and biologic treatments. Some key points to consider include:

• The use of immunosuppressive drugs such as mycophenolate mofetil and cyclophosphamide, as well as glucocorticoids, to achieve remission or low disease activity 2, 3, 4, 5
• The introduction of biologic agents, such as rituximab, belimumab, and anifrolumab, which have shown efficacy in treating SLE and lupus nephritis 2, 3, 5
• The importance of achieving remission, as it significantly improves long-term prognosis and patient survival 4
• The use of conservative therapeutic measures for nephroprotection, which play a crucial role in renal prognosis 6
• The consistent use of basic measures, such as hydroxychloroquine, optimization of cardiovascular risk factors, UV protection, bone-protective measures, and implementation of vaccinations 6

Treatment Options

Some treatment options for SLE with lupus nephritis include:

• Mycophenolate mofetil, which has become more commonly used in recent years 4
• Rituximab, a chimeric monoclonal antibody targeting CD20+ B cells, which has shown efficacy in treating SLE and lupus nephritis 5
• Belimumab, a biologic drug that inhibits the activity of B lymphocytes 3
• Anifrolumab, a biologic drug that inhibits the activity of type I interferons 3
• Voclosporin, a calcineurin inhibitor that is a novelty in lupus nephritis treatment 3

Goals of Treatment

The main goals of treatment for SLE with lupus nephritis are to:

• Achieve remission or low disease activity 3, 4
• Protect against disease flares 3
• Prevent late disease complications, especially cardiovascular risk management 3, 6
• Improve quality of life, which can be achieved through non-pharmacological therapy options such as exercise therapy 6