BACKGROUND: The treatment of Lupus Nephritis (LN) is an unmet need in the 
management of patients with Systemic Lupus Erythematosus (SLE). 
CASE PRESENTATION : We report two cases of women affected by Lupus Nephritis 
(LN) ISN/RNP Class IV with serological active disease, high disease activity and 
marked fatigue. In both cases, Mycophenolate mofetil (MMF), as induction 
therapy, was poorly tolerated because of gastrointestinal toxicity. Belimumab, 
together with low-doses of MMF, was effective as induction treatment leading to 
early achievement of complete renal response in these two selected cases of LN.
CONCLUSIONS: We also report a literature review concerning the efficacy and 
safety of Belimumab in Lupus Nephritis. Further studies are needed to evaluate 
the use of Belimumab to manage the renal involvement in patients with Systemic 
Lupus Erythematosus, waiting for the results of ongoing randomized clinical 
trials.