9 Lupus Nephritis Studies that Should be on Your Radar

September 20, 2019

Amy Reyes

Investigators are currently pursuing at least 50 possible new treatments, or treatment targets, for systemic lupus and lupus nephritis. We're tracking the studies and in this slideshow, we highlight the results from nine new studies on lupus nephritis.

Four reasons why refractory lupus nephritis is so hard to treat. In a review article published in the July 12 issue of Open Access Rheumatology, Yo JH et al. outline four problems associated with treating refractory lupus nephritis.

1) Refractory disease is generally assessed using clinical parameters and renal biopsies. But clinical parameters can be unreliable and renal biopsies are not often performed in a standard, or even timely, fashion.

2) There is a difference between clinical and immunological response to therapy. 30-40 percent of patients who atained clinical remission still had persistent inflammation.

3) There is no international consensus on what constitutes refractory lupus nephritis so as a result, clinicians may not know how best to treat these patients.

4) It can be difficult to determine if the treatment failed due to non-adherence or whehter it was a true primary treatment failure. And, "the time point at which non-response becomes treatment failure is unclear."

Ultrasound scan of human kidneys. (©AlexandrMitiuc,AdobeStock,94381112)

Lupus Nephritis Contributes to Pregnancy Complications. Lupic nephritis was predictive of a preterm delivery and preeclampsia in a study of adverse pregnancy outcomes in women with systemic lupus erythematosus, Palma Dos Reis CR et al. report in the August 23 issue of Clinical Reviews in Allergy and Immunology. The study included 157 pregnancies in which the main risk factors for gestational loss were maternal age and the presence of antiphospholipid antibodies. Renal involvement and lupus flares during pregnancy were risk factors for fetal growth restriction, but the main main risk factor for an adverse pregnancy outcome were lupus flares. (©Tobilander,AdobeStock_100070471)

Fetal Complications Frequent in Lupus Nephritis. A Chinese study published online September 7 in the journal Lupus, finds that fetal complications are frequent in patients with lupus nephritis. The study included 203 patients with lupus nephritis and of these, 103 had adverse pregnancy outcomes. 66 pregnancies ended in pre-ter births. The incidence rate of intrauterine growth restriction was 18.2 percent (37 of 203 pregnancies). Fetal distress was noted in 23 pregnancies.

Here's Why Immunoglobulin Levels Should be Tested First Before Treatment for Lupus Nephritis. Immunoglobulin levels should be assessed prior to starting B-cell therapy in patients with lupus nephritis patients, say researchers writing in the August 21 issue of BMC Rheumatology. This was a cross-sectional study of immunoglobulin levels in lupus nephritis patients. While polyclonal hypergammaglobulinemia occurred in 15 of 83 patients, immunoglobulins levels were lower (IgA, IgG and IgM). "Immunoglobulin abnormalities are frequently found in lupus nephritis, ranging from polyclonal hypergammaglobulinemia to hypogammglobulinemia," researchers wrote.

Syphilis False Positives in SLE and Lupus Nephritis. It is common for patients with systemic lupus erythematosus (SLE) to have false-positive results for syphilis and now, a new study published August 29 in the journal Rheumatology International shows that patients with false positive tests for syphilis, have lower systemic lupus disease activity at diagnosis, but higher thrombotic risk. The study included 145 patients of whom 20 had false positives for syphilis and 125 tested negative. Those who tested negative had higher SLE disease activity at diagnosis, but they also had a higher incidence of lupus nephritis. Those with false posititives had high levels of serum total protein and some anti-cardiolipin antibodies. (©VChalup,AdobeStock_102623801)

A Prognostic Biomarker for Lupus Nephritis. There is no prognostic biomarker for lupus nephritis, but researchers writing in the Sept. 17 issue of International Journal of Molecular Sciences, may have found an early biomarker in a receptor called neuropilin-1 (NRP-1). Levels of NRP-1 are generally heightened in kidney biopsies from lupus nephritis patients. While there are biomarkers understudy to diagnose the condition, this would be a potential biomarker to assess prognosis. "Our results show that patients with active lupus nephritis have increased levels of urinary NRP-1," Torres-Salido MT, et al. wrote. (©Witthaya, AdobeStock_176036456)

Elevated homocysteine level may indicate lupus nephritis. Lupus nephritis patients may be at higher risk for developing elevated levels of the amino acid homocysteine, researchers reported in the July 2 issue of Cureus. Elevated homocysteine levels in the blood are typically associated with atherosclerosis and blood clots, but increased levels are seen in approximately 15 percent of patients with systemic lupus erythematosus. Now, in a small study of 15 lupus nephritis patients, researchers found that 66.6 percent (10 patients) of the group had elevated levels. Ten of the patients had elevated homocysteine levels. The patients ranged in age from 21-68 years and most were African-American females with advanced disease. Of 10 patients with elevated levels, five had positive anti-dsDNA, and four had hypocomplementemia predominately low C3 (three patients). (Histology of human tissue, show nephritis as seen under the microscope (©Bondarau,AdobeStock_167970342)

Dendritic Cell Analysis Under Study for Lupus Nephritis Diagnostic Test. Patients with severe lupus nephritis have lower numbers of plasmacytoid dendritic cells, shows a study published on August 27 in Frontiers in Immunology. The research shows that myeloid dendritic cells may be associated with the early, mild stage of the disease. The research is early, but should future research confirm these findings, a simple flow cytometry analysis could replace invasive kidney biopsies to diagnose renal involvement in systemic lupus erythematosus (SLE). (©FreshIdea,AdobeStock)