Terapia imunológica na nefrite lúpica: uma revisão narrativa.

Abstract

Lupus Nephritis (LN) is a severe complication associated with Systemic Lupus Erythematosus (SLE), characterized by immune-mediated glomerular inflammation that may progress to renal failure. As a rheumatologic disease, its course involves alternating periods of exacerbation and disease control. Although conventional treatments based on immunosuppressants and corticosteroids are considered safe and effective, many patients fail to achieve adequate control of LN activity and experience progressive renal damage over time. In this context, monoclonal antibodies emerge as a promising therapeutic approach, offering not only safety and efficacy but also targeted action on specific immune regulation pathways, thereby reducing the adverse effects associated with traditional therapies. This study aims to critically analyze the use of rituximab and belimumab in the treatment of refractory lupus nephritis through a narrative literature review. The research was conducted in the CAPES Periodicals, Virtual Health Library (BVS), PubMed, and SciELO databases, including only articles published in Portuguese or English between 2020 and April 2025, using the inclusion descriptors: ‘Immunotherapy’ and ‘Lupus Nephritis’; and the exclusion descriptors: ‘children’, ‘pregnant women’, and ‘elderly’. Literature reviews, studies with fewer than 50 patients, and articles not available in the public domain were excluded. After applying the inclusion and exclusion criteria, seven articles were selected for this narrative review, which discuss the impact of belimumab and rituximab on the control of autoimmune renal activity. It is concluded that monoclonal antibody therapy, in addition to being an innovative strategy, is effective for the treatment of refractory lupus nephritis and positively influences the clinical course of patients with extensive renal damage. However, further studies are needed to confirm its potential as a first-line therapy for cases of focal and diffuse LN, with or without nephrotic features, particularly in preventing progression to end-stage renal disease.