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Community Minded

What defines remission in lupus nephritis?  
Five years ago, a 48-year-old woman with class 4 DPGN lupus nephritis went into complete clinical remission in 6 months after being treated with mycophenolate mofetil (MMF) and steroids. Since then, she has been maintained on MMF and is doing great clinically, but her anti-double-stranded DNA is 100 (nl < 10) and C3 is low at 60. Should you stop immunosuppression (IS)? How long should maintenance IS continue and should serologic activity play into that decision? Should you be doing protocol biopsies? What do you think?

Summary provided by Roger Rodby, MD, FASN.
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