Treatment of Lupus Nephropathy

Abstract

It is reasonably certain that the pathogenesis of systemic lupus erythematosus (SLE) involves the deposition of soluble immune complexes in the wall of small vessels of synovia, skin and various organs, including the kidneys, resulting in an inflammatory tissue reaction. It seems likely that variations in the quantitative aspects of the immunologic reaction result in differences in the extent and intensity of pathological changes and clinical manifestations of SLE. During the past decade, numerous analyses of patients have shown that renal involvement in SLE includes a wide spectrum of histopathologic changes and may occur in more cases than previously appreciated, whether or not clinical manifestations of renal disease are present. Hopefully, future studies will elucidate the basic etiology of the aberrant immunologic reaction in SLE and permit therapy to be directed at the underlying disorder. Until that information is available, however, therapy will continue to be determined by empirical observations in carefully defined subgroups of patients treated with specific drug regimens. Data derived from clinicopathologic correlations will be of critical importance in designing clinical trials to determine the efficacy of therapy in lupus nephropathy.