The Evolution of Lupus Nephritis Therapy from the 1960s to the Present

Lupus nephritis (LN) stands out as one of the most critical complications of systemic lupus erythematosus (SLE), affecting almost 60% of the patient population. Even though more therapies have been made available for LN in the past decade, clinical outcomes remain less than ideal: nearly 10% to 30% of LN cases still advance to end-stage kidney disease (ESKD), still making the management of LN a clinical challenge. Therefore, the primary aim of treatment of LN is simple: to halt the progression toward chronic kidney disease (CKD) and prevent renal failure. In this review, we briefly describe the immunopathological basis of LN, which provides the scientific rationale for new drug development. We will focus on the current in-use medications, especially on proliferative LN, building on the legacy of the 20th century, and we will outline new emerging targeted and innovative therapies. We will also present the standard-of-care as informed by international guidelines and review the management of special groups, including children and pregnant women.