Published online Sep 24, 2014. doi: 10.5500/wjt.v4.i3.176
Revised: April 24, 2014
Accepted: July 17, 2014
Published online: September 24, 2014
Despite improvements in overall prognosis in lupus nephritis, 10%-30% of patients with proliferative renal involvement progress to end stage renal disease, according to the severity of the disease and associated socioeconomic factors. Kidney transplantation has been recognized as the most appropriate treatment for those patients, but several issues remain after renal function restoration in a lupus recipient. Among these are the fear of lupus nephritis recurrence in the graft, the choice of immunosuppressive therapy in cases of recurrent lupus for a patient who has already received a toxic and prolonged immunosuppressive course, and finally, the management of comorbidities to reduce associated morbidities in the long term. All the above topics are examined in this review, with the hope of providing a clear picture of data as illustrated in the current literature.
Core tip: Significant improvement has been made in the management of lupus nephritis, but 10%-30% of patients with proliferative renal involvement still progress to end stage renal disease, according to the severity of the disease and associated socioeconomic factors. Kidney transplantation has been recognized as the most appropriate treatment for those patients, but several issues remain after renal function restoration in a lupus recipient. This review provides insights into topics such as the frequency of lupus nephritis recurrence in the graft, the choice of immunosuppressive therapy in such cases and the management of comorbidities to reduce associated morbidities in the long term.