Lupus Nephritis

Publication Date: May 3, 2012

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...