Immunosuppressive therapy of lupus nephritis

Aggressive immunosuppressive therapy should be considered for patients with proliferative lupus nephritis as the risk for progression to end stage ren al disease is high. intermittent intravenous cyclophosphamide therapy impro ves renal survival; longer duration of therapy is associated with fewer rel apse of nephritis and decreased risk of diminished renal function. While az athioprine therapy does not differ statistically from steroids alone in pro longing renal survival, this therapy may be considered in patients with few risk factors for progression to renal insufficiency. Methylprednisolone as a single therapy does not prolong renal survival compared with regimens in cluding cyclophosphamide. Plasmapheresis remains under study but has not sh own additional benefit in treatment of severe lupus nephritis. The potentia l roles for cyclosporin A and mycophenylate mofetil in the therapy of proli ferative lupus nephritis remain to be defined. Supportive care including ri gorous control of hypertension, consideration of angiotensin receptor inhib ition or blockade to reduce proteinuria and prolong renal function, control of hyperlipidemia, prevention of osteoporosis, and prevention of pregnancy remain important clinical goals. Current research efforts focus on genetic and socioeconomic factors involved in racial differences in expression of lupus nephritis, hormonal manipulation to preserve gonadal function during cyclophosphamide therapy, and the potential impact on lupus activity of est rogen-containing oral contraceptives or postmenopausal hormone replacement therapy.