Lupus nephritis and kidney transplantation: past, present and future

Background: Systemic lupus erythematosus (SLE), an autoimmune inflammatory disease that affects various organ systems, has a severe form called lupus nephritis (LN). The management of LN has changed over the past few decades due to the discovery of new immunosuppressive drugs and advances in our understanding of the disease process. This study evaluates lupus nephritis and kidney transplantation in the past, present, and future challenges. Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to evaluate the challenges of lupus nephritis and kidney transplantation management according to past, present, and future data. Results: Treatment strategies for LN typically involve a combination of immunosuppressive medications, such as corticosteroids, cyclophosphamide, and mycophenolate mofetil, to induce and maintain remission. Many LN patients progress to ESRD, necessitating renal replacement therapy (RRT) through dialysis or kidney transplantation. The results of kidney transplantation in LN patients have been progressively improving. Developing novel immunosuppressive agents may improve graft survival and reduce complications in LN patients undergoing kidney transplantation. Conclusion: The future of kidney transplantation for LN patients appears promising, with emerging research focused on novel immunosuppressive agents, personalized medicine, biomarkers for predicting recurrence and graft rejection, preventive strategies for recurrent LN, and cell-based therapies.