Lupus Nephritis: What to Do Until the Data Arrive

Abstract

For nephrologists in clinical practice the management of a patient with progressive diminution of renal function due to nephritis in systemic lupus erythematosus provokes a stress-inducing dilemma. Is the risk of therapy warranted by potential benefit? Impressions as to the efficacy of treatment of lupus nephritis with corticosteroids and cytotoxic drugs have been drawn from very few controlled studies. There are only 3 reasons for advising a treatment regimen: (1) it is of proven efficacy, (2) a study of efficacy is being conducted, (3) despite intensive treatment a fatal outcome is imminent. When considering immunosuppressive drugs and lupus nephritis, reason 1 is unsatisfied, while reason 3 has been supplanted by available dialysis and transplantation. The need for prospective controlled studies of efficacy (reason 2) is indicated.