SLE nephritis: Review of pathogenesis and treatment

Whilst acknowledging "remarkable" recent progress in our understanding of the immunology and phenotype of lupus nephritis, a recent review calls for improved clinical trial design and collaboration to improve patient outcomes.In their review Dr Anne Davidson and Dr Cynthia Aranow (Colombia University Medical Centre, New York) focus on developments in the pathogenesis and treatment of systemic lupus erythematosus (SLE) nephritis over the last year and a half.The authors highlight the characteristic glomerular and tubulointerstitial inflammation resulting from deposition of immune complexes and the many modulating factors including; genetic predisposition, products of the innate immune system, cytokines, complement and activated cells (both renal and immune).Drs Davidson and Aranow continue by discussing new clinical trials in biologic and non-biologic agents together with advances in the development of biomarkers for nephritis, pointing out that the development of new therapeutics for SLE is progressing rapidly as knowledge of pathogenic mechanisms increases.However, the authors identify that much of this work is in preventive approaches rather than those inducing remission: "It is also important to note that studies using targeted gene deletion address the relevance of a particular target with respect to disease initiation but may not necessarily predict a therapeutic effect during the effector stages of disease," they note.The authors comment, "despite recent advances, treatment of SLE nephritis remains a challenging clinical problem". "Given the variability of disease among SLE patients and the molecular heterogeneity observed in renal biopsies, even those with comparable histology, therapeutic interventions are likely not to be successful in all patients and careful consideration will need to be given to trial design."Reference...