Nephritis, or inflammation of the kidneys, is one of the most common and most serious issues for patients with systematic lupus erythematosus. According to a recent review, up to 25 percent of lupus patients develop end stage renal failure within 10 years of the onset of kidney disease. Early detection and treatment are essential for recovery. This presents a challenge, because significant kidney damage can be done before symptoms are obvious.
End stage renal disease from lupus has a higher incidence in geographic areas with limited access to health care. This suggests that careful monitoring may improve the prognosis significantly. Nephritis tends to have flares and remissions. One of the challenges is how these stages are defined. Researchers are still working to find the best test methods. The gold standard is renal biopsy, but this is too invasive to be a routine monitoring test.
Standard blood and urine tests for kidney function are important, but not as informative as the renal biopsy. Researchers have identified seven additional blood tests and eight additional urine tests that correlate with lupus nephritis in cross-sectional studies. The authors of Reference 4 suggest that longer term studies are needed.
A number of anti-inflammatory and immunosuppressive drugs are used to treat lupus nephritis. A recent article recommends treatment tailored to the individual patient based on the following criteria:
1. Class and severity of the nephritis
2. Predictors of outcome
3. Ethnicity of the patient
4. Patient's desire to have children
I found 62 trials with the search words “lupus nephritis” currently listed on the clinicaltrials.gov website. Most of these involve drug treatment. A recent review and meta-analysis reported that mycophenolate mofetil and cyclophosphamide produce similar remission rates. Adverse events were also similar, except that the mycophenolate mofetil group had less leukopenia. Trials still in progress are comparing other drug regimens.
Lupus patients with nephritis have a 2.8-fold increased risk of acute myocardial infarction (heart attack).
See your doctor for what the latest results mean for you.