Kidney Week Educational Symposia-More Options and More to Come: Update on the Management of Lupus Nephritis

Video Transcription

Video Summary

The session “More Options and More to Come” updates lupus nephritis (LN) management, with talks on disease mechanisms/monitoring (Samir Parikh) and treatment (Brad Rovin). LN affects ~40–50% of people with SLE, often early, and still carries substantial risks of kidney failure and mortality. Severity and outcomes are worse in Black and Hispanic patients, due to socioeconomic factors plus biologic contributors such as genetics (e.g., APOL1 and FCγR2A variants).<br /><br />Pathogenesis is complex: loss of tolerance to nuclear antigens leads to autoantibodies, immune-complex deposition, complement activation, and sustained innate/adaptive immune dysregulation that drives renal inflammation and damage. Kidney biopsy remains the diagnostic gold standard; importantly, severe LN can occur even with low-level proteinuria, particularly with active urine sediment. Repeat biopsies may help guide duration of immunosuppression: persistent histologic activity despite clinical remission predicts flare risk, while low activity may identify patients who can safely taper therapy. Noninvasive biomarkers are emerging; urine soluble CD163 correlates with histologic severity, predicts response, and rises before flares.<br /><br />Treatment advances include FDA approval of voclosporin and belimumab added to standard therapy, improving complete renal response with similar short-term safety to placebo. Rovin proposes monitoring early response (≥25% proteinuria reduction and stable/improving GFR) to decide whether to add these agents, with selection influenced by trial subgroup signals (e.g., voclosporin for rapid proteinuria reduction; belimumab for flare prevention and kidney-function preservation). More therapies targeting complement, interferon, cytokines, and costimulation are in development.

Asset Subtitle

Moderators: Andrew Bomback

Speakers:

Introduction - Andrew Bomback
Pathogenesis, Diagnosis, and Surveillance of Lupus Nephritis - Samir Parikh
Treatment of Lupus Nephritis - Brad Rovin

Meta Tag

Date 11/4/2021

Pathway 1 Glomerular Diseases

Session ID 408977

Session Type ES - Educational Symposium

Keywords

lupus nephritis

systemic lupus erythematosus

kidney biopsy

proteinuria monitoring

urine soluble CD163 biomarker

voclosporin

belimumab

immune complex complement activation

racial disparities APOL1 FCGR2A