Management of chronic renal insufficiency in lupus nephritis: Role of proteinuria, hypertension and dyslipidemia in the progression of renal disease

Non-immune mechanisms appear to be important in the majority of patients wi th lupus nephritis and progressive renal injury. Proteinuria, hypertension and dyslipidemia are associated nonimmune risk factors often implicated in the deterioration of kidney function. There is ample animal experimental ev idence that they are independent risk factors for progressive renal injury and their treatment results in amelioration of renal function. Proteinuria and hypertension, unlike dyslipidemia, have been shown to be independent ri sk factors for progressive renal injury in patients with lupus nephritis. T reatment of hypertension and proteinuria in the diabetic and nondiabetic pr ogressive renal disease population results in stabilization of kidney funct ion. Response to treatment should target both blood pressure of 120/80 and significant reductions in protein excretion. If protein excretion rate is u naltered by use of an angiotensin-converting enzyme inhibitor and salt rest riction, one might resort to the use of an angiotensin II antagonist. Treat ment of the dyslipidemia following good control of proteinuria, blood press ure and dietary change may not alter renal progression but should provide s imilar protection from accelerated vascular disease to the non-renal dyslip idemia population.