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
...Diagnosis...
...Case Definition...
...Renal Biopsy an...
...ACR recommends that all patients with cl...
...ACR agrees that class I (minimal mesangial im...
...ble 1. International Society of Ne...
Table...
...rum creatinine without compelling alternative...
...rmed proteinuria of ≥1.0 gm per 24 hour...
...ns of the following, assuming the findings are...
Treatment
...Treatment...
...Adjunctive Treatm...
...ACR recommends that all SLE patients with ne...
...ents with proteinuria ≥0.5 gm per 24 hours (o...
The ACR recommends that careful attention be p...
...e ACR also recommends that statin therapy b...
...ACR recommends that women of child-bear...
...Recommendations for In...
...ACR recommends mycophenolate mofetil (MM...
...compared to non-Asians, might req...
...recommends that MMF and MPA are likely to be...
...“Euro-Lupus” CYC (500 mg IV once ever...
...high-dose CYC (500–1,000 mg/m2 IV once a month...
...s being considered for treatment, the ACR recommen...
...IV glucocorticoids (500–1,000 mg...
...ACR recommends that most patients be...
...commends that MMF was preferable to CYC f...
...Recommendations fo...
...e ACR recommends either CYC or MMF for i...
...R recommends that patients with pu...
...Re...
...mmends that either AZA or MMF be used for maint...
...Recommendations for Ch...
...tients who fail to respond after 6 months of tre...
...ACR also voted that in some cases rituximab can...
...tis is worsening in patients treated for 3 m...
...ecommends that thrombotic microangi...
...Treatme...
...th prior LN but no current evidence of systemic o...
...tients with mild systemic activity may be...
...ically active nephritis is present, or there is su...
...th a persistently active nephritis with documente...
...Monitoring Act...
Recommendations for monitoring LN are shown in Ta...
...Class III/IV Induction Therapy...
.... Treatment of Class III, IV, and V in Patients W...
...ment of Class V with Proteinuria ≥3...
...mmended Monitoring of Lupus Nephritis (monthly...