Systemic Lupus Erythematosus and Lupus Nephritis: Diagnosis, Management and Therapeutic Advances

Abstract

Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune disease, with an abnormal interaction between innate and adaptive immunity. This study is an integrative review carried out from June to July 2024, based on 10 articles found in PubMed, in the last 10 years. This condition can manifest itself in several organ systems of the body, which can result in fatal complications involving vital organs and tissues. Renal involvement is common among patients with SLE, with the presence of lupus nephritis (LN) being its most evident clinical manifestation, with a difficult diagnosis in both SLE and LN. SLE is associated with several autoantibodies that attack nuclear antigens, causing damage during the course of the disease. LN affects a large proportion of patients with SLE, characterized by complex inflammatory kidney lesions, which, due to limited access to healthcare, can worsen the progression of the disease, progressing to end-stage renal disease (ESRD). LN presents a more complex diagnostic challenge than SLE, due to the possibility of patients being asymptomatic in the early stages of the disease, a time when treatment would be ideal. Renal biopsy is the current standard for diagnosis and is used repeatedly to investigate the evolution of LN. However, there is also disease tracking through biomarkers, which play an important role in analyzing disease activity and response to therapeutic interventions. Another diagnostic mechanism for LN is the urine test, investigating creatinine and proteinuria levels. For effective treatment, prior diagnosis of the disease is extremely necessary, predicting a good long-term renal prognosis if there is an early response.