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
...gnosis...
...for Lupus Nephritis (LN)...
...l Biopsy and Histol...
...ommends that all patients with clinical ev...
...he ACR agrees that class I (minimal mesangial i...
...1. International Society of Nephrology/Rena...
...2. Indications For Renal Biopsy In Patients With...
...m creatinine without compelling alternative ca...
...med proteinuria of ≥1.0 gm per 24 hours (e...
...inations of the following, assuming the ...
Treatment
Treatme...
...djunctive Treatments
...nds that all SLE patients with nephritis...
All LN patients with proteinuria ≥0.5 gm per 24...
...commends that careful attention be...
...ecommends that statin therapy be introduc...
...ds that women of child-bearing pote...
...mendations for Induction of Improvement in P...
...ommends mycophenolate mofetil (MMF...
...compared to non-Asians, might require l...
...CR recommends that MMF and MPA are lik...
...uro-Lupus” CYC (500 mg IV once every 2 weeks for...
...-dose CYC (500–1,000 mg/m2 IV once a month...
...s being considered for treatment, th...
...IV glucocorticoids (500–1,000 mg methylpr...
...nds that most patients be followed for 6 months...
...e ACR recommends that MMF was preferable to CYC...
...for Induction of Improvement in Patients With Cl...
...recommends either CYC or MMF for ind...
...ations for Induction of Improvement in Patients Wi...
...ACR recommends that patients with pur...
...endations for Maintaining Improvement in Patients...
...ends that either AZA or MMF be use...
...ommendations for Changing Therapies in Pati...
...fail to respond after 6 months of treatme...
...ed that in some cases rituximab can be use...
...s is worsening in patients treated f...
...recommends that thrombotic microangio...
...nt of LN in Patients Who Are Pregnant
...patients with prior LN but no current evide...
...ts with mild systemic activity may be treated wi...
...tive nephritis is present, or there...
...tients with a persistently active ne...
...oring Activity of LN...
...mmendations for monitoring LN are shown in Tabl...
...re 1. Class III/IV Induction Therapy
...ent of Class III, IV, and V in Patients Who...
...e 3. Treatment of Class V with Proteinu...
...3. Recommended Monitoring of Lupus Nephri...