Nephritis, or inflammation of the kidneys, is one of the most common and most serious issues for patients with systematic lupus erythematosus. According to a recent review, up to 25 percent of lupus patients develop end stage renal failure within 10 years of the onset of kidney disease. Early detection and treatment are essential for recovery. This presents a challenge, because significant kidney damage can be done before symptoms are obvious.

End stage renal disease from lupus has a higher incidence in geographic areas with limited access to health care. This suggests that careful monitoring may improve the prognosis significantly. Nephritis tends to have flares and remissions. One of the challenges is how these stages are defined. Researchers are still working to find the best test methods. The gold standard is renal biopsy, but this is too invasive to be a routine monitoring test.

Standard blood and urine tests for kidney function are important, but not as informative as the renal biopsy. Researchers have identified seven additional blood tests and eight additional urine tests that correlate with lupus nephritis in cross-sectional studies. The authors of Reference 4 suggest that longer term studies are needed.

A number of anti-inflammatory and immunosuppressive drugs are used to treat lupus nephritis. A recent article recommends treatment tailored to the individual patient based on the following criteria:
1. Class and severity of the nephritis
2. Predictors of outcome
3. Ethnicity of the patient
4. Patient's desire to have children

I found 62 trials with the search words “lupus nephritis” currently listed on the clinicaltrials.gov website. Most of these involve drug treatment. A recent review and meta-analysis reported that mycophenolate mofetil and cyclophosphamide produce similar remission rates. Adverse events were also similar, except that the mycophenolate mofetil group had less leukopenia. Trials still in progress are comparing other drug regimens.

Lupus patients with nephritis have a 2.8-fold increased risk of acute myocardial infarction (heart attack).

See your doctor for what the latest results mean for you.

References:

1. Lightstone L, “Lupus nephritis: where are we now?”, Curr Opin Rheumatol. 2010 May; 22(3): 252-6.

2. Kamanamool N et al., “Efficacy and adverse events of mycophenolate mofetil versus cyclophosphamide for induction therapy of lupus nephritis: systematic review and meta-analysis”, Medicine (Baltimore). 2010 Jul; 89(4): 227-35.

3. Wells DK et al., “Nephritis and the risk of acute myocardial infarction in patients with systemic lupus erythematosus”, Clin Exp Rheumatol. 2010 Mar-Apr; 28(2): 223-9.

4. Mok CC, “Biomarkers for lupus nephritis: a critical appraisal”, J Biomed Biotechnol. 2010; 2010:638413.

5. Ward MM, “Access to care and the incidence of endstage renal disease due to systemic lupus erythematosus”, J Rheumatol. 2010 Jun; 37(6): 1158-63.

6. Clinical trials:
http://clinicaltrials.gov/ct2/results?term=lupus+nephritis

7. More information online:
http://kidney.niddk.nih.gov/kudiseases/pubs/lupusnephritis/

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.