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Journal of Nephrology

, Volume 29, Issue 4, pp 559–565 | Cite as

Remission and withdrawal of therapy in lupus nephritis

  • Gabriella MoroniEmail author
  • Francesca Raffiotta
  • Claudio Ponticelli
Review

Abstract

There is agreement that early diagnosis and aggressive treatment of lupus nephritis exacerbations are of paramount importance to achieve remission and prevent the development of irreversible lesions. There is less agreement about the optimal duration of maintenance treatment. Instead, the prolonged exposure to corticosteroids and/or immunosuppressive drugs can cause invalidating or even life-threatening complications. It is still unclear if these drugs can be safely withdrawn in lupus patients. We were able to completely withdraw therapy in around 1/3 of our patients after a follow-up of 5 years or more; 60 % of them never had to start therapy again. Based on our own experience, discontinuation of therapy should be applied only in selected cases, i.e. patients who received maintenance therapy for at least 5 years and are in complete renal remission for at least 3 years. Antimalarial agents are helpful in maintaining the remission after withdrawal of therapy. However, to achieve these goals, drugs should be tapered off very slowly and under strict surveillance. If all these prerequisites are satisfied, the withdrawal of therapy in patients with lupus nephritis may be considered safe, may improve the patients’ quality of life and may reduce the damage accrual.

Keywords

Lupus nephritis Corticosteroids Immunosuppressive agents Remission Withdrawal of therapy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of human rights

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Italian Society of Nephrology 2016

Authors and Affiliations

  • Gabriella Moroni
    • 1
    Email author
  • Francesca Raffiotta
    • 1
  • Claudio Ponticelli
    • 1
    • 2
  1. 1.Unità Operativa di Nefrologia e DialisiFondazione IRCCS Cà Granda Ospedale Policlinico MilanoMilanoItaly
  2. 2.Nephrology UnitClinical and Research Center HumanitasRozzanoItaly

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