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NDT Advance Access originally published online on April 27, 2006
Nephrology Dialysis Transplantation 2006 21(6):1465-1469; doi:10.1093/ndt/gfl208
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Editorial Comment

Discontinuation of immunosuppression in proliferative lupus nephritis: is it possible?

Cecile Grootscholten and Jo H. M. Berden

Division of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Correspondence and offprint requests to: Cecile Grootscholten, MD, Radboud University Nijmegen Medical Centre, Division of Nephrology (464), PO Box 9101, 6500 HB Nijmegen, The Netherlands. Email: m.grootscholten@aig.umcn.nl

Keywords: lupus nephritis; immunosuppression withdrawal

The first 150 words of the full text of this article appear below.



   Introduction
 
The search for an optimal therapy for proliferative lupus nephritis (LN) is still ongoing [1,2]. Maintenance treatment most often consists of low-dose prednisone, generally combined with either azathioprine, hydroxychloroquine or mycophenolate mofetil.

Since the prognosis of proliferative LN has improved considerably and the morbidity of therapy is substantial, the aim of treatment has changed from preventing mortality to diminishing morbidity. Because of the cumulative side effects of long-term immunosuppression, there is a constant effort to keep drug therapy at a minimum and, wherever possible, to discontinue it altogether. Compared with other manifestations of systemic lupus erythematosus however, physicians may be more reluctant to discontinue therapy in patients with LN, especially since each flare is considered a risk factor for a worse renal outcome.

So far, no randomized controlled studies have been carried out in which maintenance treatment after reaching remission was withdrawn prospectively.



   Relapses during immunosuppressive therapy
 
Exacerbations in proliferative . . . [Full Text of this Article]



   Relapses after minimization or discontinuation of immunosuppressive therapy
 


   When and how to withdraw immunosuppressives
 


   Conclusions and guidelines
 

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