Lupus Nephritis: A Brief Review

Source: Adobe Stock | Sebastian Kaulitzki

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 in Asians, African Americans and Hispanics than in other races and ethnic groups.^2-6 Up to 60% of patients with SLE in these groups develop renal disease of differing severity during the course of their illness.

Lupus nephritis can cause hyper­tension and kidney failure. Patients with lupus nephritis also have a higher risk of heart and blood ves­sel problems as a well as a higher risk of developing cancer, especially B cell lymphoma, than their counterparts without lupus neph­ritis in the general population.⁷

Both SLE 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.⁸

The kidney damage caused by lupus nephritis is irreversible and associated with renal failure, cardiac events and death.⁹

Treatment

Rheumatologists had few treatment options for patients with lupus neph­ritis until December 2020, when belimumab was approved by the U.S. Food & Drug Administra­tion (FDA). A few weeks later, in January 2021, the FDA also approved voclosporin, a calci­neurin inhibitor, to be used in combination with background immunosuppressive therapy to treat adults with active lupus nephritis.^10,11

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.

Clinical Guidance

Today, clinicians also have a new evidence-based guideline from the ACR to reference for the screening, treatment and management of lupus nephritis.

“Important goals of this guideline are to provide substance and direction for therapy decisions after clinician-patient discussions, and to encourage close working relationships between rheuma­tologists and nephrologists to enhance collaborative care,” wrote the guideline authors.

Further research is needed, and more treatment options would be welcome, but it’s important to recognize the progress that has been made to date in the treatment and monitoring of patients with lupus nephritis.

Keri Losavio is the staff editor of The Rheumatologist.

References

1. Liu CC, Kao AH, Manzi S, Ahearn JM. Biomarkers in systemic lupus erythematosus: Challenges and prospects for the future. Ther Adv Musculoskelet Dis. 2013 Aug;5(4):210–233.
2. Dooley MA, Hogan S, Jennette C, et al. Cyclophosphamide therapy for lupus nephritis: Poor renal survival in Black Americans. Kidney Int. 1997; 51:1188–1195.
3. Mok CC, Tang SK. Incidence and predictors of renal disease in Chinese patients with systemic lupus erythematosus. Am J Med. 2004; 117:791–795.
4. Bastian HM, Roseman JM, McGwin G Jr, et al, LUMINA Study Group.Systemic lupus erythematosus in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis. Lupus. 2002;11:152–160.
5. Sanchez E, Rasmussen A, Riba L, et al. Impact of genetic ancestry and sociodemographic status on the clinical expression of systemic lupus erythematosus in American Indian–European populations. Arthritis Rheum. 2012;64:3687–3694.
6. Feldman CH, Hiraki LT, Liu J, et al. Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000–2004. Arthritis Rheum. 2013;65:753–763.
7. Lupus nephritis. Mayo Clinic. 2025 Jan 31.
8. Mok CC, Kwok RCL, Yip PSF. Effect of renal disease on the standardized mortality ratio and life expectancy of patients with systemic lupus erythematosus. Arthritis Rheumatol. 2013 Aug;65(8):2154–2160.
9. Anders HJ, Saxena R, Zhao MH, et al. Lupus nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7.
10. FDA approves GSK’s Benlysta as the first medicine for adult patients with active lupus nephritis in the U.S. (news release). GlaxoSmithKline plc. 2021 Dec 17.
11. FDA approves Aurinia Pharmaceuticals’ Lupkynis (voclosporin) for adult patients with active lupus nephritis (news release). Aurinia Pharmaceuticals Inc. 2021 Jan 22.