Lupus Nephritis
Key Points
Key Points
- In the US, approximately 35% of adults with systemic lupus erythematosus (SLE) have clinical evidence of nephritis at the time of diagnosis, with an estimated total of 50–60% developing nephritis during the first 10 years of disease.
- The prevalence of nephritis is significantly higher in African Americans and Hispanics than in whites, and is higher in men than in women.
- Renal damage is more likely to develop in nonwhite groups.
- Overall survival in patients with SLE is approximately 95% at 5 years after diagnosis and 92% at 10 years after diagnosis. The presence of lupus nephritis (LN) significantly reduces survival to approximately 88% at 10 years, with even lower survival in African Americans.
Diagnosis
...agnosi...
Case Definition for Lupus Nephritis (LN...
...nal Biopsy and Histolo...
...mmends that all patients with clinical evidenc...
...agrees that class I (minimal mesangial imm...
...tional Society of Nephrology/Renal Pathology S...
...e 2. Indications For Renal Biopsy In Pat...
...asing serum creatinine without compelling al...
...firmed proteinuria of ≥1.0 gm per 24 hours...
...tions of the following, assuming the find...
Treatment
...reatment
...unctive Treatments...
...ACR recommends that all SLE patients with ne...
...ll LN patients with proteinuria ≥0.5 gm per 24...
...mends that careful attention be paid to cont...
...ecommends that statin therapy be introduced in...
...recommends that women of child-bearing p...
Recommendations for Induction of Impr...
...nds mycophenolate mofetil (MMF) (2–3 gm tota...
...ompared to non-Asians, might require lower...
...R recommends that MMF and MPA are likely to be...
...low-dose “Euro-Lupus” CYC (500 m...
...high-dose CYC (500–1,000 mg/m2 I...
...YC is being considered for treatment, t...
...glucocorticoids (500–1,000 mg met...
...recommends that most patients be followed fo...
...ends that MMF was preferable to CYC for p...
...for Induction of Improvement in Patients With Cl...
...commends either CYC or MMF for indu...
...mmendations for Induction of Improvement...
...ACR recommends that patients with...
...tions for Maintaining Improvement in Patients Wh...
...ecommends that either AZA or MMF be use...
...ions for Changing Therapies in Patients...
...who fail to respond after 6 months o...
...CR also voted that in some cases r...
...worsening in patients treated for 3 months with g...
...he ACR recommends that thrombotic microangiop...
...f LN in Patients Who Are Pregnant...
...ients with prior LN but no current evidence of...
...ients with mild systemic activity may be t...
...inically active nephritis is present, or ther...
For patients with a persistently activ...
Monitoring Activity of LN
...mendations for monitoring LN are sho...
...ure 1. Class III/IV Inducti...
.... Treatment of Class III, IV, and V in...
Figure 3. Treatment of Class V with Prot...
...ommended Monitoring of Lupus Nephritis (monthly i...