An update on the management of comorbid conditions in lupus nephritis

Author(s): Vassiliki Tzavara, Cristina Pamfil, Dimitrios T Boumpas, George K Bertsias

Patients with lupus nephritis suffer from excessive morbidity and mortality compared with patients without renal involvement and the general population. Over the past few decades, early mortality in lupus nephritis due to uncontrolled renal disease activity and acute renal failure has decreased, whereas cardiovascular, metabolic, infectious comorbidities and malignancies have emerged as important long-term complications. Their pathogenesis involves chronic inflammatory burden, exposure to drugs with high toxicity potential (particularly glucocorticoids), and metabolic abnormalities due to impaired renal function. Although the lupus literature lacks controlled data for the management of most of the aforementioned disorders, there is evidence from other patients with chronic kidney disease to guide therapeutic decisions. Importantly, a multitargeted approach is recommended, which includes adequate control of disease activity with minimization of exposure to glucocorticoids, tight control of cardiovascular risk factors, and prompt identification and management of other chronic kidney disease comorbidities according to existing recommendations.