The most commonly used steroid-sparing drugs in lupus nephritis include cyclophosphamide (Cytoxan), mycophenolate (CellCept) and azathioprine (Imuran). Cyclophosphamide has historically been the standard treatment for the most severe forms of lupus nephritis, but has several potential negative side effects. (See section on lupus medications) In fact, all drugs have potential side-effects. Thus, your doctor will aim for optimal control of kidney disease with a variety of medications and dosages that may vary over time, in an effort to limit side effects while maximizing benefit. If the blood pressure is high, medication to treat this (anti-hypertensive) may also be prescribed. Two very important types of medications for people with active kidney dis- ease are ‘angiotensinogen converting enzyme (ACE) inhibitors’ (for example Monopril®, Lisinopril, etc.) and ‘angiotensin receptor blockers’ (ARB’s), such as Cozaar®. Diuretic agents may be used to relieve swelling due to excess fluid in the body, and your doctor may recommend dietary changes including reduced salt, protein and calorie intake, and possibly restricted intake of water and potassium (found in many foods, especially certain fruits and vegetables). If the damage is severe and the kidneys fail, dialysis or a kidney transplant may be necessary. Over the past few decades, we have learned a lot about lupus nephritis and treatment has improved. It is hoped that with additional research, fewer and fewer lupus patients will suffer kidney damage. 25