Lupus nephritis: A simplified approach to diagnosis and treatment in South Africa

Abstract

Lupus nephritis (LN) is a significant cause of morbidity and mortality in patients with systemic lupus erythematosus. Delayed recognition
and diagnosis of LN may be a common cause of chronic kidney disease among South Africans. Renal biopsy is the gold standard of
diagnosing LN; however, this service is not available in many centres and the use of urinalysis, urine microscopic examination and other
serological tests can be useful in identifying patients with proliferative LN. Proliferative types of LN (class III, class IV and mixed class V)
comprise the larger proportion of patients with this condition. Patients receiving immunosuppressive therapy need to be monitored closely
for side-effects and drug-related toxicities. LN patients with end-stage renal disease (class VI) need to be prepared for renal replacement
therapy (dialysis and renal transplantation). In all patients, treatment should include adjunctive therapies such as renin angiotensin
aldosterone system blockade, bone protection (with calcium supplements and vitamin D), blood pressure control and chloroquine – all of
which help to retard the progression of kidney disease.