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)...
Renal Biopsy and Hist...
The ACR recommends that all patien...
...he ACR agrees that class I (minimal mesangial...
...tional Society of Nephrology/Renal Pathology S...
...cations For Renal Biopsy In Patients With Syst...
...rum creatinine without compelling alternati...
...ed proteinuria of ≥1.0 gm per 24 hours (either...
...ombinations of the following, assuming th...
Treatment
Treatmen...
...ve Treatments...
...mmends that all SLE patients with nephritis be tre...
...with proteinuria ≥0.5 gm per 24 hour...
...nds that careful attention be paid to control...
The ACR also recommends that statin therapy be in...
...mends that women of child-bearing potenti...
...for Induction of Improvement in Patients With IS...
...ACR recommends mycophenolate mofetil (...
...mpared to non-Asians, might require lower doses o...
...ommends that MMF and MPA are likel...
...uro-Lupus” CYC (500 mg IV once every...
...ose CYC (500–1,000 mg/m2 IV once a mont...
...is being considered for treatment, the A...
...ocorticoids (500–1,000 mg methylpr...
...ACR recommends that most patients be follo...
...ACR recommends that MMF was preferable to CYC fo...
...mendations for Induction of Improvement in Patient...
...recommends either CYC or MMF for indu...
...mmendations for Induction of Improveme...
...CR recommends that patients with pure class V LN...
Recommendations for Maintaining Improv...
...ommends that either AZA or MMF be u...
...s for Changing Therapies in Patients...
...fail to respond after 6 months of treatmen...
...ted that in some cases rituximab can be used in p...
...phritis is worsening in patients tr...
...nds that thrombotic microangiopathy be...
...reatment of LN in Patients Who Ar...
...n patients with prior LN but no current...
...with mild systemic activity may be treated with H...
...inically active nephritis is present, or...
...nts with a persistently active nephri...
...toring Activity o...
...for monitoring LN are shown in Table 3. (C)7...
...1. Class III/IV Induction Th...
...igure 2. Treatment of Class III, IV, and...
...ment of Class V with Proteinuria ≥3g/24h...
.... Recommended Monitoring of Lupus...