This study states that Renal involvement in systemic lupus erythematosus (SLE) occurs in 40–50% of adult patients, is associated with increased morbidity and mortality, and results in endstage renal disease (ESRD) about 10% of patients – rates that have changed little over the last 2 decades despite modifications in therapeutic strategies1.

In all of us there is a gradual decline in kidney function that occurs with age, with estimates of losses of 0.4–1 ml/min/year in those over 30 years of age being reported2,3. Assuming a normal glomerular filtration rate (GFR) of 100 ml/min in early adulthood and assuming no changes in this rate due to intercurrent illnesses, our kidney function is sufficient to last a lifetime. However, in the presence of renal disease, for example, diabetic nephropathy or polycystic kidney disease, rates of loss of kidney function can be 10-fold greater or more, in turn meaning there is a significant chance of needing renal replacement therapy in the form of dialysis or transplantation during a patient’s lifetime. In addition, modest reductions in GFR are associated with significant increases in overall and specific cardiovascular mortality. We know that certain interventions can slow down this rate, blood pressure control being the main factor, and specific interventions such as good glycemic control and novel sodium-glucose linked transporter (SGLT)2 inhibitors for diabetes, or vasopressin receptor antagonists for polycystic kidney disease, respectively. What about other conditions where kidney decline is not a continuous process but has a more episodic character.

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