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 f...
Renal B...
...recommends that all patients with clinical ev...
...hat class I (minimal mesangial immu...
...e 1. International Society of Nephrology/Renal...
...Table 2. Indicatio...
...asing serum creatinine without compelling alternat...
...rmed proteinuria of ≥1.0 gm per 24 hours (eit...
...nations of the following, assuming th...
Treatment
...Treatment...
...Adjunctive...
...ommends that all SLE patients with nep...
...nts with proteinuria ≥0.5 gm per 24 hours (or eq...
...mends that careful attention be paid to...
...ACR also recommends that statin therapy...
The ACR recommends that women of child-...
...Recomm...
...ends mycophenolate mofetil (MMF) (...
..., as compared to non-Asians, might req...
...ommends that MMF and MPA are likely...
1. low-dose “Euro-Lupus” CYC (500 m...
...gh-dose CYC (500–1,000 mg/m2 IV on...
...considered for treatment, the ACR recommend...
...rticoids (500–1,000 mg methylpredn...
...mends that most patients be followed for 6 mo...
...recommends that MMF was preferable to CY...
...Recomme...
...commends either CYC or MMF for induction of...
...Rec...
...mends that patients with pure class V LN a...
...R...
...commends that either AZA or MMF be used for mai...
...Reco...
...patients who fail to respond after 6 mont...
...ed that in some cases rituximab can be used in p...
...s worsening in patients treated for 3 mont...
...CR recommends that thrombotic microang...
...Treatment of LN in Pat...
...ients with prior LN but no current...
...mild systemic activity may be trea...
...clinically active nephritis is present,...
...patients with a persistently active nep...
...Monitoring Activ...
...ons for monitoring LN are shown in Table 3...
...1. Class III/IV Induction Therapy...
Figure 2. Treatment of Class III, IV, and...
...tment of Class V with Proteinuria ≥3g...
...commended Monitoring of Lupus Nephritis (monthl...