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
Diagnos...
...for Lupus Nephritis (LN)...
...opsy and Histology...
...CR recommends that all patients with clinica...
...ACR agrees that class I (minimal mesangial immu...
...le 1. International Society of Nephrology/Renal P...
...ications For Renal Biopsy In Patients With System...
Increasing serum creatinine withou...
Confirmed proteinuria of ≥1.0 gm per 24 ho...
...tions of the following, assuming the find...
Treatment
...atment...
...unctive Treatments...
...ACR recommends that all SLE patients wit...
...nts with proteinuria ≥0.5 gm per 24 ho...
...commends that careful attention be...
...commends that statin therapy be intr...
...ends that women of child-bearing pot...
...mmendations for Induction of Improvement in Patie...
...ACR recommends mycophenolate mofetil...
...sians, as compared to non-Asians, m...
...recommends that MMF and MPA are likely to be eq...
...low-dose “Euro-Lupus” CYC (500 m...
...CYC (500–1,000 mg/m2 IV once a month...
...g considered for treatment, the ACR recom...
...ucocorticoids (500–1,000 mg methylprednisolo...
The ACR recommends that most patients...
...ACR recommends that MMF was preferable...
...ecommendations for Induction of Impro...
...ds either CYC or MMF for induction of i...
...ons for Induction of Improvement in...
...ecommends that patients with pure class V LN an...
...ions for Maintaining Improvement in Patients...
The ACR recommends that either AZA or MMF be use...
...ions for Changing Therapies in Patients W...
...tients who fail to respond after 6 month...
...oted that in some cases rituximab can be...
...itis is worsening in patients trea...
...ACR recommends that thrombotic microangiopathy...
...ment of LN in Patients Who Are...
...prior LN but no current evidence of systemi...
...with mild systemic activity may be...
...y active nephritis is present, or there is s...
...or patients with a persistently active neph...
...ring Activity of...
...ndations for monitoring LN are shown in Ta...
...re 1. Class III/IV Induction Therapy...
...e 2. Treatment of Class III, IV, and V i...
...gure 3. Treatment of Class V with Proteinuria ≥3...
...ommended Monitoring of Lupus Nephritis (mon...