Surveillance and management strategies for lupus nephritis: A practical summary guide for clinical settings lacking specialist care and expert histopathology

Abstract

Lupus nephritis may be the presenting feature of Systemic Lupus Erythematosus (SLE) and is often an early complication of the disease affecting up to half of patients with SLE. It is a major cause of morbidity and mortality. It is typically heralded by the silent onset of proteinuria, then may progress to a clinically evident edematous state with hypertension and renal impairment. The overarching goals of treatment of lupus nephritis include patient survival, preservation of kidney function, prevention of disease flares and organ damage, management of comorbidities, and improvements in disease-related quality of life. Management of active lupus nephritis should include an initial period of intense immunosuppressive therapy (induction) followed by a longer period of maintenance therapy. In the English-speaking Caribbean, as in many developing states, the lack of specialists results in non-specialists having to manage cases of lupus nephritis often with limited resources and guidance. We proffer a 14-step approach which highlights key issues and allows the novice doctor to gain some level of comfort and confidence when faced with the daunting task of having to function as a combined nephrologist/rheumatologist and assume responsibility for care of patients with this most challenging condition. It begins with case ascertainment by formal screening and home testing for proteinuria and continues with guides to the more widely available immunosuppressive therapy and addresses supportive care including a guide to effective blood pressure control.