Lupus Nephritis: Natural History, Prognosis and Treatment

Lupus nephritis is composed of a continuum of clinical and morphological features. The World Health Organization classification delineates categories of lupus nephritis which have some unique characteristics. However, its utility for assessing prognosis and indications for treatment can be enhanced by supplementary description of activity and chronicity features of the renal pathology.

The prognosis of all forms of lupus nephritis has improved over the past several decades as a result of improved ancillary medical therapies and more effective immunosuppressive regimens. Some patients with active lupus nephritis may respond dramatically and completely to high-dose prednisone. More commonly, such therapy achieves incomplete responses and disposes patients to a high probability of progressive renal scarring and a substantial risk of end-stage renal failure. Conventional cytotoxic drug therapy with azathioprine or cyclophosphamide reduces the likelihood of unfavourable renal outcomes, but this advantage is offset by a number of potentially serious side-effects. Intermittent pulse cyclophosphamide treatment produces the lowest risk of renal failure and appears to have a substantially reduced rate of toxicity.