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Understanding Lupus Nephritis Diagnosis and Treatment

Core Concepts
Lupus nephritis diagnosis and treatment overview.
Introduction to the podcast series on chronic kidney disease with Dr. Matthew Sparks and Dr. Dawn Caster. Dr. Caster's interest in nephrology and lupus nephritis. Overview of lupus nephritis and its classification based on immune complex deposits. Clinical manifestations and classifications of lupus nephritis. Discussion on systemic lupus criteria and kidney involvement. Treatment approach for class 1 or 2 lupus nephritis. Explanation of podocytopathy and its treatment. Induction therapy options for severe lupus nephritis. Use of steroids in lupus nephritis treatment. Introduction of novel agents like voclosporin and belimumab. Discussion on CAR T-cell therapy for lupus nephritis. Consideration of SGLT2 inhibitors in lupus nephritis treatment. Conclusion and future perspectives on lupus nephritis treatment.
"Complete response on these standard-of care-therapies is less than 50% at 6 months." "Voclosporin or belimumab are not used in isolation." "The response rates for standard-of-care therapy are very low."
"I think one of the most critical things in the treatment of lupus is making sure there is adherence because nonadherence is a big cause of failure of therapy." "I tend to give IV steroids at the start." "I'm always happy to have more tools to take care of my patients because the response rates for standard-of care-therapies are very low."

Key Insights Distilled From

by Matthew A. S... at 07-25-2023
S2 Episode 2: Is It Lupus Nephritis? A Path to Diagnosis and Treatment

Deeper Inquiries

How can the classification system for lupus nephritis be improved to encompass all possible kidney manifestations?

The classification system for lupus nephritis primarily focuses on immune complex glomerulonephritis and the deposition of immune complexes in different parts of the glomerulus. To encompass all possible kidney manifestations, the classification system could be expanded to include additional categories beyond immune complex deposition. This could involve incorporating subcategories for non-immune complex-related kidney involvement seen in lupus, such as antiphospholipid antibody syndrome-related thrombotic microangiopathy (TMA), tubular basement membrane deposits, vascular lesions, and pure podocytopathy. By broadening the classification system to account for these diverse manifestations, clinicians can better understand and manage the full spectrum of kidney involvement in lupus nephritis.

How can the use of SGLT2 inhibitors be optimized in patients with lupus nephritis who are on immunosuppression therapy?

The use of SGLT2 inhibitors in patients with lupus nephritis who are on immunosuppression therapy requires careful consideration due to potential risks and benefits. While SGLT2 inhibitors have shown promise in delaying progression of chronic kidney disease and reducing cardiovascular risk, their use in patients on immunosuppression needs further research. To optimize their use in this population, several strategies can be employed: Patient Selection: Identify patients with lupus nephritis who have maximized immunosuppression and show no signs of active inflammation. These patients may benefit from SGLT2 inhibitors to manage chronic kidney disease. Monitoring: Regular monitoring for genitourinary infections, a known risk associated with SGLT2 inhibitors, is essential in patients on immunosuppression. Close surveillance can help detect and manage any potential infections promptly. Data Collection: Encourage participation in studies evaluating the use of SGLT2 inhibitors in patients with lupus nephritis on immunosuppression. Generating more data specific to this population will provide insights into the safety and efficacy of these agents. Shared Decision-Making: Engage in shared decision-making with patients to discuss the potential benefits and risks of SGLT2 inhibitors in the context of their individual disease status and treatment regimen. This collaborative approach can help tailor the use of SGLT2 inhibitors to each patient's unique needs. By implementing these strategies, clinicians can optimize the use of SGLT2 inhibitors in patients with lupus nephritis on immunosuppression therapy while ensuring patient safety and treatment efficacy.

How can the classification system for lupus nephritis be improved to encompass all possible kidney manifestations?

CAR T-cell therapy has shown impressive results in very resistant patients with lupus nephritis, leading to almost complete resolution of symptoms. However, the use of CAR T-cell therapy in a larger patient population comes with both potential risks and benefits that need to be carefully considered: