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An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Lupus Nephritis FocusRheum

Both systemic lupus erythematosus and lupus nephritis reduce a person’s life expectancy, with SLE cutting an average of 12.4 years off a person’s life expectancy and lupus nephritis reducing life expectancy by another 2.7 years, according to a study by Mok et al. “Thus, the occurrence of renal damage is an important adverse factor for survival in patients with SLE,” they wrote. Treatment is aimed at reducing symptoms, preserving kidney function and avoiding the need for dialysis or kidney transplant, reducing morbidity and mortality, and minimizing medication-related toxicities. Review our collection of articles on the topic below. Features are added often, so check back frequently.

FEATURED ARTICLE: Lupus Nephritis: A Brief Review

 

Lupus Nephritis, a Supplement to The Rheumatologist

Rheuminations: Can We Now Control the Wolf?

Lupus has always had a reputation for being a wild, unrestrained and enigmatic entity. In fact, the very name lupus comes from the Latin word for wolf, a gift from our Roman predecessors who saw a resemblance between lupus rashes and a wolf’s bite. Given the limitations of immunology back then, it is an incredibly…

FDA Approvals: Lupus Nephritis

Lupus nephritis is one of the leading causes of mortality for patients with systemic lupus erythematosus (SLE), and patients with both SLE and end-stage renal disease have standardized mortality ratios more than 60 times that of patients with SLE with normal kidney function.1 The good news: Rheumatologists now have not one, but two approved options…

Trials Find Potential Treatments for SLE, Lupus Nephritis

In summer 2024, two phase 3 studies were released with promising findings for the treatment of patients with systemic lupus erythematosus (SLE) and those with lupus nephritis. SLE Disease Activity Dapirolizumab pegol is a novel, investigational, Fc-free anti-CD40L agent for people living with moderate to severe SLE.1 The randomized, double-blind, parallel-group PHOENYCS GO trial (N=321)…

Belimumab Promising for Children with Lupus Nephritis

In late July 2022, the U.S. Food & Drug Administration (FDA) approved belimumab (Benlysta) for the treatment of children with active lupus nephritis aged 5 to 17 years old receiving standard therapy.1 Despite recent advances in treatment options for patients with systemic lupus erythematosus (SLE), those with kidney involvement may develop endstage renal disease and…

Kidney Biopsy in Lupus Nephritis

As part of a session on lupus nephritis at ACR Convergence 2023, Simone Appenzeller, MD, PhD, shared perspectives on the importance of biopsy to inform the diagnosis, prognosis and treatment of the condition, with an emphasis on childhood disease. Prompt diagnosis and treatment of lupus nephritis is perhaps even more important for children than for…

The ACR Releases New Lupus Nephritis Guideline

At a session of ACR Convergence 2024, speakers shared key elements of the new guideline on the screening, treatment and overall management of lupus nephritis in children and adults.1 This guideline attempts to balance the risks of medication side effects with the important goal of preserving kidney function. This is the ACR’s first lupus guideline…

Research Reviews: AURORA 2, & Urinary Biomarkers

AURORA 2 Voclosporin, a novel calcineurin inhibitor (CNI), is associated with a favorable metabolic profile with regard to lipids and glucose, and a predictable pharmacokinetic profile, resulting in no need for the therapeutic drug monitoring required of other CNIs. AURORA 2, a double-blind, phase 3 study, evaluated the longterm safety, tolerability and efficacy of voclosporin…

Autoantibodies Illuminate Lupus Nephritis

In this study, Fava et al. investigated longitudinal autoantibody profiles in a racially diverse cohort of patients with lupus nephritis to define noninvasive serological biomarkers of histologic class and one-year treatment response to standard of care. In addition, the researchers determined how these biomarkers changed over time to provide further insights into treatment response and…

Case Report: Lupus Nephritis, or a Mimic?

Syphilis, an ancient disease caused by the spirochete Treponema pallidum, has been historically referred to as the great mimicker given its heterogenous presentation. Both systemic lupus erythematosus (SLE) and syphilis can have multi-systemic involvement. Both parvovirus B19 and syphilis have been reported to cause histologic features similar to those seen in lupus nephritis. We present…

B Cell-Depleting Therapy in SLE & Lupus Nephritis

“B cells are central orchestraters of autoimmune disease by contributing to autoantibody production, antigen presentation and cytokine production,” says Georg Schett, MD, head of the Department of Medicine 3 (Rheumatology and Immunology) of the Friedrich-Alexander University Erlangen-Nürnberg, Germany. “B cells can be inhibited by monoclonal antibodies and chimeric antigen receptor (CAR) expressing cells.” Dr. Schett…

Research, Case Reports & More

Lupus Nephritis: A Brief Review

Among patients with sys­temic lupus erythematosus (SLE), lupus nephritis is one of the more common health problems and a leading cause of mortality. In adults with SLE, as many as five of 10 will develop kidney disease. In children with lupus, eight of 10 will develop kidney disease.1 Lupus nephritis appears to be more prevalent…

Autoantibodies Illuminate Lupus Nephritis

Fava et al. investigated longitudinal autoantibody profiles in patients with lupus nephritis (LN) to define serological biomarkers of histologic class. They found that baseline levels of anti-C1q and anti-double-stranded DNA antibodies may serve as noninvasive biomarkers of proliferative LN and anti-C1q antibodies may predict complete response.

Glucocorticoids Increase Infections, Mortality

Figueroa-Parra et al. set out to evaluate the effect of glucocorticoid regimens on renal response, infections and mortality rates among patients with lupus nephritis (LN). The researchers analyzed the control arms of randomized clinical trials and found a higher exposure to glucocorticoids during the initial treatment of LN was associated with better renal outcomes, at the cost of increased infections and mortality.

Kidney Biopsy in Lupus Nephritis

SAN DIEGO—As part of a Nov. 14 session on lupus nephritis at ACR Convergence 2023, Simone Appenzeller, MD, PhD, shared perspectives on the importance of biopsy to inform its diagnosis, prognosis and treatment, with an emphasis on childhood disease. Prompt diagnosis and treatment of lupus nephritis is perhaps even more important for children than for…

A Case of Lupus Podocytopathy

Kidney involvement is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Collectively termed lupus nephritis, SLE with kidney involvement comes in many subtypes. The current classification by the International Society of Nephrology/Renal Pathology Society (ISN/RPS), however, does not include lupus podocytopathy, which, through various clinical and epidemiologic studies, has recently been…

The Risk of Cardiovascular Events in Patients with RA & More Explored in 3rd Plenary Session

SAN DIEGO—In one presentation at Plenary Session 3, ACR Convergence 2023, Beth Wallace, MD, MSc, a staff physician at the VA Ann Arbor Healthcare System, Michigan, and an assistant professor at the University of Michigan, Ann Arbor, shared important data on the relationship between time-dependent cumulative glucocorticoid exposure and major adverse cardiovascular events (MACE) in a cohort of veterans with rheumatoid arthritis (RA).

Long-Term Voclosporin Treatment Looks Promising for Lupus Nephritis Patients

AURORA 2, a double-blind, phase 3 study, evaluated the long-term safety, tolerability and efficacy of voclosporin compared to placebo in patients with lupus nephritis receiving an additional two years of treatment following completion of the one-year AURORA 1 study. Patients enrolled in AURORA 2 continued to receive the same treatment randomly assigned in AURORA 1, in combination with mycophenolate mofetil and low-dose glucocorticoids. Saxena et al. propose that the rapid renal response achieved with voclosporin treatment has long-term benefits, supported by stable kidney function over the three-year treatment period.