The Treatment of Lupus Nephritis in 2008, 60 Years on

Surprisingly, given its very high incidence and prevalence in all populations outside Africa with a \Yest African genetic component, lupus nephritis seems not to be common in West Africa. although its presence is probably under-reported. Nevertheless, it is an important disease for which successful- but toxic - treatments are available. For forty years no new therapies were introduced after the major advances of the 1950s and 1960s. but now in the 1990s and 2000s major advances are again being made. with the introduction of exciting agents capable of modifying the course of the disease, some based directly on new knowledge of immunology at a cellular and molecular level. Unfortunately, some of these new agents are poorly available. and all are expensive. Treatment of lupus and its nephritis falls into an induction phase followed by a maintenance phase. in which treatment goals and problems encountered are different. This article review s briefly the options available now and suggests courses of treatment based on a database increasingly made ur 0:' information derived from randomised. prospective controlled trials. Much of this information, however, relates to Caucasian or Chinese populations. and its applicability to Africans is unknown.