Lupus Nephritis Treatment and Research

 

 

Lupus nephritis is an autoimmune condition in which the body mistakenly attacks healthy kidney cells. Therefore, your healthcare provider will treat it with medicines that suppress your immune system and concurrently reduce inflammation. Further treatment goals depend upon your lupus nephritis classification and may involve medications used to restore and maintain kidney function. Medications used to treat lupus nephritis include:

  • Hydroxychloroquine  – an antimalarial drug which is commonly used in the treatment and prevention of lupus flares.
  • Mycophenolate mofetil – an immunosuppressive drug which has become first line therapy in the treatment of lupus nephritis due to its safety profile.   
  • Corticosteroids (usually prednisone) – immunosuppressive drugs which are very commonly used in the treatment and prevention of lupus flares. New research and drugs have allowed for the use of lower dose corticosteroids in lupus nephritis, which reduce the side effect burden in patients. 
  • Cyclophosphamide – an immunosuppressive drug which is sometimes used in treatment resistant patients. 
  • Blood Pressure medications such as:
    • ACE inhibitors or ARBS’s – help protect your kidneys from further damage. 
    • Diuretics – help to remove excess fluid from the body and therefore reduce burden on the kidneys. 
    • Beta blockers or calcium channel blockers – help restore kidney function and protect the heart.

 

New Therapies – Hope for better efficacy and lower side effects. 

  • Belimumab  (monoclonal antibody) – Significantly improves kidney disease activity and reduces lupus flares while allowing steroid dose reduction. 
  • Voclosporin (calcineurin Inhibitors) – When added to standard of care therapy, this medication helps to suppress the immune system and protect the kidneys. In some patients, it may result in complete renal remission rates. 

 

For many years, high dose corticosteroids, cyclophosphamide, or mycophenolate were used for the treatment of lupus nephritis, and although they were useful in reducing inflammation in the kidneys, they did not come without unwanted side effects. Recent clinical trials have shown that lower doses of these medications remain beneficial when used in conjunction with other immunosuppressants. The newly approved medications listed above do not completely replace them but rather help to reduce their dose size and avoid unwanted side effects. 

 

In this podcast, Dr. Brad Rovin, a nephrologist, touches upon medication side effect profiles and provides insight into research that proves lower doses of toxic medications can still be effective. He also talks about having hope, staying healthy, and being an advocate for yourself. It’s a quick listen- maybe something to do while you go on an evening walk!  

 

New Research

In the past few years, the FDA has approved several new drugs for SLE and lupus nephritis. Many more are in the development pipeline and it wouldn’t surprise me to see them become approved soon. This is proof that research works.

While we are on the topic of research, an exciting new study found that there are 52 genes involved in the expression of lupus nephritis. This matters because the identification of these genes could help to understand which symptoms are linked to which genes and why some people get sicker than others. This can then be used to create targeted and personalized therapies. Lupus braves know just how challenging lupus can be- from diagnosis to treatment. Perhaps personalized medicine is the step towards treating and eventually curing a very complex condition. 

 

 

By Nadia Bhatti

Related Story