Morales E, Galindo M, Trujillo H, Praga M: Update on Lupus Nephritis: Looking for a New Vision. Nephron DOI 10.1159/000511268
Lupus nephritis (LN) continues to be a challenging disorder for both nephrologists and rheumatologists. This topic is an ever-changing one and the pace of change appears to be accelerating as new data on prognostication and management emerge.
Morales et al. from Spain have nicely summarized recent developments in a very well-written review focusing on prognostic biomarkers, kidney biopsy (including protocol-driven repeat biopsies), biologic therapies, lupus podocytopathy, membranous LN, anti-phospholipid antibody syndrome, kidney transplantation, and the duration of immunosuppressive therapy in LN. The field of LN is moving toward a more “personalized” approach to management and away from the “one-size-fits-all” paradigm that has dominated thinking for many years. Novel serum or urinary biomarkers and refined analysis of kidney biopsy specimens seem to be a promising avenue of research, but much more work needs to be done before these tools reach routine clinical utility.
The very encouraging findings with novel biological therapies and new immunosuppressive regimens (such as belimumab, obinutuzumab, and anifrolumab)  and a reanalysis of older data concerning rituximab seems to indicate that a new paradigm of management of LN is on the horizon – one that may substantially reduce the reliance on high-dose steroid therapy with its attendant side effects. The recently released studies of the BLISS-LN trial of belimumab, the phase 3 trial of voclosporin, and the phase 2 trial of obinutuzumab in LN are particularly encouraging.
This review article is strongly recommended for those nephrologists and rheumatologists who want to remain current in the status of LN as of the summer of 2020.
1. Narain S, Berman N, Furie R. Biologics in the treatment of Sjogren’s syndrome, systemic lupus erythematosus, and lupus nephritis. Curr Opin Rheumatol. 2020 Nov;32(6):609–16.