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

...gnosis...

...n for Lupus Nephritis (LN)...


...iopsy and Histology...

...commends that all patients with clinical e...

...that class I (minimal mesangial im...

Table 1. International Society of Neph...

...ions For Renal Biopsy In Patients With Systemic L...

...m creatinine without compelling alternati...

...onfirmed proteinuria of ≥1.0 gm per 24 h...

...ions of the following, assuming the findi...


Treatment

Treatmen...

...tive Treatments...

...commends that all SLE patients wit...

...with proteinuria ≥0.5 gm per 24 hours (or equiv...

...e ACR recommends that careful attention be pa...

...ACR also recommends that statin ther...

...ds that women of child-bearing potential with...


...dations for Induction of Improvement in Patient...

...he ACR recommends mycophenolate mofe...

...compared to non-Asians, might require lowe...

...nds that MMF and MPA are likely to be e...

...e “Euro-Lupus” CYC (500 mg IV on...

...CYC (500–1,000 mg/m2 IV once a month for 6 d...

...ing considered for treatment, the ACR...

...ucocorticoids (500–1,000 mg methylpredn...

...commends that most patients be followed...

...ends that MMF was preferable to CYC for p...


...for Induction of Improvement in Pati...

...e ACR recommends either CYC or MMF for inducti...


...ndations for Induction of Improvement in Pati...

...ACR recommends that patients with pure class V...


...ecommendations for Maintaining Improvement in Pati...

...e ACR recommends that either AZA or MMF be used f...


...mmendations for Changing Therapies i...

...ho fail to respond after 6 months of treatmen...

...he ACR also voted that in some cases rituximab can...

...worsening in patients treated for 3 months...

...recommends that thrombotic microangiop...


...nt of LN in Patients Who Are Pregnant...

...ts with prior LN but no current evidenc...

...mild systemic activity may be treated with HCQ...

...linically active nephritis is present, or...

...nts with a persistently active nephritis...


...ing Activity of LN...

...commendations for monitoring LN are shown in...


...Class III/IV Induction Therapy...


...Treatment of Class III, IV, and V in Patie...


...re 3. Treatment of Class V with Proteinuria ≥...


.... Recommended Monitoring of Lupus Nephritis (month...