Fahad Aziz and Kunal Chaudhary* Pages 4-13 (10)
Objective: The treatment of lupus nephritis is largely determined based on the histological class present on the renal biopsy specimen. In most cases, Class I and II of lupus nephritis do not require any specific treatment, but class III and IV lupus nephritis require immunosuppressive therapy. Treatment of Class V and VI remains controversial. In 2012, six guidelines were introduced for the management of lupus nephritis. These guidelines offer comprehensive treatment plans for each class of Lupus nephritis but differ from each other in many aspects. The purpose of this article is to review the current literature of the available pharmacological treatments used in the six classes of lupus nephritis as well as resistant lupus nephritis, strategies to address the problems of inadequate therapeutic response, medication related side effects, relapses of lupus nephritis, and some future treatment options.
Methods: We reviewed the available literature and treatment guidelines on lupus nephritis in detail to present a comprehensive review of the available treatment options for different classes of lupus nephritis.
Conclusion: Lupus nephritis which does not respond to initial treatment is associated with worse renal outcomes. Several therapeutic approaches are available for the induction and maintenance immunosuppression of the different classes of LN. Management of LN should be individualized for each patient based on their risk-benefit profile.
Lupus nephritis, classes of lupus nephritis, induction therapy, maintenance therapy, resistant lupus nephritis.
Division of Nephrology, University of Wisconsin, Madison, WI 53706, Division of Nephrology, University of Missouri Health Science Center, Columbia, MO 65212