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Main > Kidney Disease > Lupus Nephritis > Lupus Nephritis Treatment >
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Brief Introduction for the Treatment of Lupus Nephritis

2012-10-11 16:44

Lupus Nephritis or LN is kidney involvement due to immune complexes caused by SLE (Systemic Lupus Erythematosus). 50%-80% of SLE patients have kidney impairment to some extent, while 80%-100% of those patients have kidney problems when taking kidney biopsy. For a really long time, Lupus Nephritis becomes one of the major culprits accounting for the death of SLE.

Five stages are classified by WHO in 1982 in histology:

Stage I— dminimal mesangial disease looks normal under light microscopy, but mesangial deposits can be seen under electron microscopy.

Stage II—mesangial proliferative is noted by mesangial hypercellularity and matrix expansion. Microscopic hematuria can be seen, but proteinuria can develop or not.

Stage III—focal lupus nephritis is characterized by less than sclerotic lesions of 50% of the glomeruli.

Stage IV—diffuse proliferative is indicated by more than 50% of glomeruli are involved which can be global or segmental.

Stage V—membranous lupus nephritis

Diffuse thickening of glomerular capillary wall with diffuse membrane thickening and supepithelial deposits can be seen under electron microscopy.

Stage VI—also called advanced sclerosing lupus nephritis presents as more than 90% of glomeruli of global sclerosis. (According to Wikipedia)

Now, let’s get down to business. How is Lupus Nephritis treated?

Its general principle for treatment is due to the different histologies (above), diverse therapeutic schedules would be chalked out. One more point, certain cases of uremia or ESRD induced by LN in clinic can be reversed sometimes.

Be more exact, steroids or steroid therapy would be used to patients in stage I and II but no need to treat nephritis, only focus on controlling symptoms coming from SLE.

Steroids or steroid therapy are adopted when the illness condition progresses to stage III. If hormonal resistance or steroid dependent attacks, adding immunosuppressants is necessary.

For disease in stage IV, steroid pulse therapy together with coagulation may deal with the problems.

For those in stage V, immunosuppressants will be added when steroid therapy fail to function well.

However, when one progresses to stage VI, protecting kidneys is prior to any others. ACEI or ARBs along with coagulation therapy are commonly used.

Steroid therapy or steroids are the first choice for Lupus Nephritis. It works for improving symptoms of SLE but goes with a strong side effects. Relapse is easily to develop as long as drug dose is reduced.

Other than those conventional therapies, plasma exchange and immunoadsorption are novel approaches for the disease. Those two approaches could clear out a great deal of autoantibodies, CIC (circulating immune complexes), cytokines or inflammatory mediator etc. rapidly.

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Tag: Lupus Nephritis

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