Current Treatment Recommendations for Lupus Nephritis

Claudio Ponticelli

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Renal disease is common in patients with systemic lupus erythematosus and may run an extremely variable course. Specific therapy is not necessary in patients with mild kidney involvement but a careful surveillance is needed to recognise possible transformations to more severe disease classifications or flare-ups. Vigorous treatment must be started early in patients with nephritic syndrome and/or active lesions at renal biopsy, i.e. glomerular cell proliferation, necrosis and inflammation. Corticosteroids remain the cornerstone for treating lupus nephritis. However, every attempt should be made to minimise their possible toxic effects. A short course of intravenous high-dose methylprednisolone followed by moderate doses of prednisone is a relatively nontoxic regimen which is generally effective in reversing the flare-ups of the disease. Once the activity is quenched the maintenance dosage of steroids should be reduced to the lowest possible dose, trying to switch the patient to an alternate-day regimen whenever possible. In patients with persisting activity the administration of a cytotoxic agent may obviate the need for protracted high-dose corticotherapy. Intermittent intravenous cyclophosphamide pulses may be considered in nonresponding patients. Other approaches, with cyclosporin, lymphoid irradiation, etc. although promising, are still preliminary. Although we are still far from an optimal treatment of lupus nephritis, the refined use of corticosteroid and cytotoxic agents and a careful monitoring of patients may allow excellent patient and kidney survival rates for 10 or more years.

Original languageEnglish
Pages (from-to)19-30
Number of pages12
JournalDrugs
Volume40
Issue number1
DOIs
Publication statusPublished - 1990

Fingerprint

Lupus Nephritis
Cytotoxins
Adrenal Cortex Hormones
Kidney
Biopsy
Poisons
Methylprednisolone
Cell proliferation
Prednisone
Cyclophosphamide
Cyclosporine
Therapeutics
Steroids
Switches
Irradiation
Lymphatic Irradiation
Monitoring
Physiologic Monitoring
Systemic Lupus Erythematosus
Necrosis

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Toxicology
  • Health, Toxicology and Mutagenesis

Cite this

Current Treatment Recommendations for Lupus Nephritis. / Ponticelli, Claudio.

In: Drugs, Vol. 40, No. 1, 1990, p. 19-30.

Research output: Contribution to journalArticle

Ponticelli, Claudio. / Current Treatment Recommendations for Lupus Nephritis. In: Drugs. 1990 ; Vol. 40, No. 1. pp. 19-30.
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