Teoh Selene T Y, Yap Desmond Y H, Chan Tak Mao
Division of Nephrology, School of Clinical Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR.
Division of Nephrology, Department of General Medicine, Khoo Teck Puat Hospital, Singapore.
Clin Kidney J. 2024 Nov 22;18(1):sfae376. doi: 10.1093/ckj/sfae376. eCollection 2025 Jan.
Lupus nephritis is an important cause of severe glomerulonephritis, and a leading cause of kidney failure in young adults. While the disease can lead to rapid destruction of nephrons if untreated, there are effective therapies to reverse the severe acute kidney injury and prevent the lifetime risk of kidney failure. Early diagnosis and timely intervention are therefore of critical importance. Clinical management of lupus nephritis has improved considerably over the past two decades. The advent of mycophenolate as standard immunosuppressive therapy was a major paradigm shift that improved the safety and convenience of treatment and also patients' quality of life. Effective therapeutic options continue to increase, such as belimumab (a monoclonal antibody that inhibits B-cell activating factor, BAFF) and voclosporin (a calcineurin inhibitor) which have obtained regulatory approval in U.S.A. and Europe. There is also accumulating experience on tacrolimus, which has regulatory approval for lupus nephritis treatment in Japan and commonly used off-label in many countries. Ironically, the increasing therapeutic options have resulted in uncertainties in deciding which medication, and which treatment regimen, is best for a patient. In this context, one needs to take into consideration the distinct characteristics and the risk profile of each patient, and adopt a holistic and long-term perspective, so that treatment can be personalized to achieve favourable clinical outcomes.
狼疮性肾炎是严重肾小球肾炎的重要病因，也是年轻成年人肾衰竭的主要原因。如果不进行治疗，该疾病可导致肾单位迅速破坏，但有有效的疗法可逆转严重的急性肾损伤并预防终身肾衰竭风险。因此，早期诊断和及时干预至关重要。在过去二十年中，狼疮性肾炎的临床管理有了显著改善。霉酚酸酯作为标准免疫抑制疗法的出现是一个重大的范式转变，提高了治疗的安全性和便利性，也改善了患者的生活质量。有效的治疗选择不断增加，例如贝利尤单抗（一种抑制B细胞活化因子BAFF的单克隆抗体）和voclosporin（一种钙调神经磷酸酶抑制剂）已在美国和欧洲获得监管批准。他克莫司也有越来越多的应用经验，它在日本已获得狼疮性肾炎治疗的监管批准，并且在许多国家常用于非标签治疗。具有讽刺意味的是，治疗选择的增加导致在决定哪种药物和哪种治疗方案最适合患者时存在不确定性。在这种情况下，需要考虑每个患者的独特特征和风险状况，并采取整体和长期的观点，以便使治疗个性化以实现良好的临床结果。
