Lupus-Nephritis – viel hilft viel?

Die Lupus-Nephritis ist eine schwere Manifestation des Systemischen Lupus erythematodes, die bis zur Dialysepflicht führen kann. Zielgerichtete immunmodulierende Therapien und nephroprotektive Maßnahmen verbessern die renale Prognose und reduzieren die glukokortikoidassoziierte Toxizität. Studien belegen, dass Multi-Target-Therapien unter Einbezug von Calcineurin-Inhibitoren oder Belimumab einer Therapie mit Einzelsubstanzen überlegen sind. Eine vielversprechende Perspektive könnte die CAR-T-Zell-Therapie darstellen.

Abstract

Lupus nephritis (LN) is a frequent and often serious manifestation of systemic lupus erythematosus, which can lead to the need for renal replacement therapy. Its timely diagnosis and treatment is therefore of crucial importance. The use of targeted immunomodulating therapies and the consistent use of nephroprotective measures in the treatment of LN can now significantly improve the renal prognosis and reduce glucocorticoid-associated toxicity. Recent study data have shown that the combination of different immunomodulating therapies including calcineurin inhibitors or belimumab is superior to therapy with single agents in terms of clinically relevant renal endpoints. This multi-target therapy has now also been included in several recently updated international guidelines. In the future, CAR-T cell therapy could be a promising prospect for patients with refractory lupus nephritis.

Kernaussagen

• Multi-Target-Therapie: Die Kombination immunmodulierender Therapien erweist sich in Studien dem bisherigen Therapiestandard überlegen und trägt zu einer geringeren kumulativen Glukokortikoid-Dosis bei.

• Neuer Calcineurin-Inhibitor: Der neuartige Calcineurin-Inhibitor Voclosporin steigert die Remissionsraten signifikant.

• Belimumab: Der BLyS-Antikörper verbessert das renale Ansprechen – vor allem bei bereits eingeschränkter Nierenfunktion und in Kombination mit MMF – signifikant.

• Progressionshemmung: Das Armamentarium progressionshemmender Substanzen in der Therapie der chronischen Niereninsuffizienz hält zunehmend Einzug in die Therapie der Lupus-Nephritis.

• Stellenwert von Re-Biopsien: Wiederholungsbiopsien können darin unterstützen, Veränderungen in der klinischen Präsentation einzuordnen und Therapie-Entscheidungen zu treffen.

Schlüsselwörter

Lupusnephritis - Multi-Target-Therapie - Nephroprotektion - Nierenbiopsie - CAR-T-Zell-Therapie

Keywords

lupus nephritis - multi-target therapy - nephroprotective measures - renal biopsy - CAR-T cell therapy

Publication History

Article published online:
31 March 2025

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