Advances in the treatment of lupus nephritis

Systemic lupus erythematosus (SLE) is an autoimmune disease that leads to t he formation and deposition of immune complexes throughout the body, which are pathogenic for the disease. Different forms of glomerulonephritis can o ccur in patients with SLE and can contribute significantly to the associate d morbidity and, ultimately, mortality from the disease. Over the past two decades, there have been significant strides in our understanding of the di sease and in treatments that attempt to control the formation and depositio n of anti-DNA auto-antibodies and immune complexes, as well as the subseque nt inflammatory cascade mediated through various cellular and humoral pathw ays leading to progressive renal damage and end-stage renal disease. In thi s chapter, we review the current understanding of the pathogenesis and trea tment of lupus nephritis in its various stages and discuss the experimental and human data regarding some of the potential newer forms of therapy. We discuss data regarding the use of steroids, azathioprine, cyclophosphamide, cyclosporine A, mycophenolate mofetil, gammaglobulin, plasmapheresis, LJP 394, flaxseed oil, bindarit, anti-CD40 ligand, and CTLA4Ig.