Assessing the Role of Hydroxychloroquine Adherence in Improving Lupus Nephritis Outcomes

Abstract

Background: Lupus nephritis (LN) is a significant morbidity factor and may cause long-lasting kidney damage in systemic lupus erythematotus (SLE). One of the cornerstone treatments is hydroxychloroquine (HCQ) that is proven to decrease the disease activity, fight exacerbations, and enhance overall survival. Nevertheless, in practice, compliance with HCQ is not very high, and its effect on renal outcomes in LN should be synthesized better.

Objective: To estimate the effect of compliance with hydroxychloroquine on the renal outcomes of patients with lupus nephritis, including the frequency of a flare, the level of the renal functioning, and the long-term organ damages.

Methods: A literature review methodology (narrative) was employed, including cohort studies conducted by peers with the review being made, and mechanistic research along with guideline statements that are related to the topic of HCQ adherence among LN. Articles that evaluated the renal flare rates, eGFR, HCQ blood level, and renal survival in the long term were encompassed.

Results: In several global cohorts, increased HCQ adherence was found to have steadily decreased the LN flare rates, decreased the proteinuria, and decreased the progression of chronic kidney damage. The number of renal relapses was considerably decreased in patients that had therapeutic levels of HCQ including those that had low or no levels. Lack of adherence contributed to the probability of corticosteroid-dependent disease activity, faster kidney deterioration, and enhanced end-stage kidney disease (ESKD). Pharmacologic proof exists to back up these results, showing that HCQ has anti-inflammatory systemic effects, complement-activation stabilization, and anti-thrombotic microangiopathy effects.

Conclusion: The rates of HCQ compliance are a sensitive adjustable variable in enhancing the outcomes of lupus nephritis. Interventions in improving adherence could have significant effects in reducing renal flares and preserving functioning of kidney and improving long-term outcome in patients with LN.