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...
...tion for Lupus Nephritis (LN)...
...enal Biopsy and Hi...
...R recommends that all patients with clinica...
...ACR agrees that class I (minimal mesangial...
...1. International Society of Nephrolo...
...ations For Renal Biopsy In Patients With...
...ing serum creatinine without compelling alte...
...onfirmed proteinuria of ≥1.0 gm...
...ns of the following, assuming the fi...
Treatment
...atment...
...ctive Treatments...
...ends that all SLE patients with nephritis be...
...with proteinuria ≥0.5 gm per 24 hours (or...
...e ACR recommends that careful attention be p...
...also recommends that statin therapy b...
...R recommends that women of child-bearing potential...
...mendations for Induction of Improvem...
...recommends mycophenolate mofetil (MMF) (2...
Asians, as compared to non-Asians, m...
...ds that MMF and MPA are likely to b...
...“Euro-Lupus” CYC (500 mg IV on...
...-dose CYC (500–1,000 mg/m2 IV once a month f...
...f CYC is being considered for treatm...
...se IV glucocorticoids (500–1,000 mg methylpred...
...ends that most patients be followed for 6 mo...
...he ACR recommends that MMF was preferable to C...
...ecommendations for Induction of Impr...
...nds either CYC or MMF for induction of...
...ons for Induction of Improvement in Patients...
...ACR recommends that patients with pure class...
...ns for Maintaining Improvement in Pati...
...e ACR recommends that either AZA or MMF be us...
...ons for Changing Therapies in Patients Who Do No...
...patients who fail to respond after 6 months o...
The ACR also voted that in some cases rituxim...
...worsening in patients treated for 3...
...ecommends that thrombotic microangiopathy be trea...
...ment of LN in Patients Who Are Pregnant...
...ts with prior LN but no current evidence of...
...ients with mild systemic activity may...
...nically active nephritis is present, or th...
...tients with a persistently active nephritis w...
...ng Activity of LN...
...for monitoring LN are shown in Tabl...
...re 1. Class III/IV Induction T...
...ent of Class III, IV, and V in Patients Who...
...igure 3. Treatment of Class V with Proteinuria ≥...
...able 3. Recommended Monitoring of Lupus Nephr...