LA TERAPIA DELLA NEFROPATIA LUPICA CON INSUFFICIENZA RENALE CRONICA

Treatment of lupus nephritis associated with end-stage renal disease Approximately 10% of patients with lupus nephritis develop end-stage renal disease (ESRD). In some cases with a rapidly progressive course, treatment may result in partial recovery of renal function. The choice of aggressive treat- ment should be balanced against the risk of enhanced morbidity due to side effects in patients with renal insufficiency; one should therefore desist from pre- venting ESRD at any cost. Renal replacement therapy (both hemodialysis and peritoneal dialysis) may offer lupus patients with ESRD good chances of sur- vival. The indications for renal replacement therapy are similar to those in other uremic patients. Systemic lupus erythematosus activity may be quenched by renal replacement therapy but it may also persist, especially during the first year. Immunosuppression and corticosteroids should be stopped when possi- ble, as lupus patients on dialysis are liable to increased morbidity consisting of infections and cardiovascular events due to side effects of therapy. The pres- ence of antiphospholipid antibodies may favor thrombotic events. Renal trans- plant offers the best rehabillitation for most lupus patients with ESRD. Many studies have reported similar patient and graft survival rates in lupus and nonlupus transplant recipients. The results are better for living-donor trans- plants. Patients with antiphospholipid antibodies have a higher graft failure risk. Active lupus and iatrogenic side effects are risk factors for enhanced mor- bidity after transplant; a 6-12 washout period before transplant is advisable for these candidates. Recurrence of lupus nephritis is a rare event which usu- ally does not compromise the outcome of the graft. (G Ital Nefrol 2008; 25: (Suppl. S44) S68-75)