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Therapy of resistant or relapsing diffuse or focal proliferative lupus nephritis

Ronald J Falk, MD
Maria Dall'Era, MD
Gerald B Appel, MD
Section Editors
Richard J Glassock, MD, MACP
Brad H Rovin, MD
Deputy Editor
Albert Q Lam, MD


Treatment of lupus nephritis (LN) varies with the type of disease (morphologic class) that is present. However, no single regimen is regarded as optimal for all patients with LN, and treatment must be individualized. Combined immunosuppressive therapy is typically indicated in patients with diffuse and focal proliferative LN and in many patients with lupus membranous nephropathy. (See "Diagnosis and classification of renal disease in systemic lupus erythematosus" and "Clinical features and therapy of lupus membranous nephropathy".)

Some patients are truly resistant to initial immunosuppressive treatments despite full compliance with the prescribed regimen. By contrast, a greater number of patients are perceived to have resistant LN.

Relapsing LN is substantially more common than resistant disease. Nearly one-half of patients with proliferative LN who initially achieve a complete response on immunosuppressive therapy will have a relapse (also called renal flare) following reduction in or cessation of immunosuppression.

The treatment of resistant and relapsing LN will be reviewed here. The treatment of proliferative LN and lupus membranous nephropathy, as well as issues related to end-stage LN, are presented separately. (See "Treatment and prognosis of diffuse or focal proliferative lupus nephritis" and "Clinical features and therapy of lupus membranous nephropathy" and "End-stage renal disease due to lupus nephritis".)


Patients who fail to achieve a response to initial immunosuppressive therapy are defined as having resistant disease. As noted above, true resistant disease is uncommon. Perceived resistance, which is more common, is often due to incomplete compliance or noncompliance with the prescribed immunosuppressive regimen or to inadequacy of the prescribed regimen.

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Literature review current through: Nov 2017. | This topic last updated: Oct 19, 2016.
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