Lupus nephritis: where are we now?

Curr Opin Rheumatol. 2010 May;22(3):252-6. doi: 10.1097/BOR.0b013e3283386512.


Purpose of review: To consider the challenges in the management of lupus nephritis with respect to diagnosis and optimal therapy for induction and maintenance of response.

Recent findings: Despite several large clinical trials in lupus nephritis, no second line drug is licensed for use in induction of remission in lupus nephritis. An important issue is how remission and flare are defined and the role of repeat renal biopsies. On the background of negative trials with mycophenolate mofetil and rituximab, there are recent data demonstrating superiority of mycophenolate mofetil in certain subgroups. New data suggest a role for tacrolimus in the treatment of lupus nephritis. Additionally, dogma is being challenged by data showing very low and even no oral steroids can be used in mycophenolate mofetil and rituximab-based regimes.

Summary: Despite the negative outcome of recent trials there is growing evidence that there are increasing opportunities in patients with lupus nephritis to offer treatments tailored to the individual needs of the patient based not only on the class and severity of their nephritis but also on their ethnicity, their desire to have children and their predictors of outcome.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents / therapeutic use*
  • Biopsy / standards
  • Drug Therapy, Combination / methods
  • Drug Therapy, Combination / trends
  • Humans
  • Immunologic Factors / therapeutic use*
  • Kidney / drug effects
  • Kidney / immunology
  • Kidney / physiopathology
  • Lupus Nephritis / drug therapy*
  • Lupus Nephritis / pathology*
  • Lupus Nephritis / physiopathology
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Rituximab
  • Steroids / therapeutic use
  • Tacrolimus / therapeutic use


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents
  • Immunologic Factors
  • Steroids
  • Rituximab
  • Mycophenolic Acid
  • Tacrolimus