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
...iagnosis...
...n for Lupus Nephritis (LN)...
...Biopsy and Histology
...R recommends that all patients with clinical evi...
...ACR agrees that class I (minimal mesang...
...national Society of Nephrology/Renal Pathology...
...ble 2. Indications For Renal Biopsy...
...serum creatinine without compelling alt...
...einuria of ≥1.0 gm per 24 hours (ei...
...ns of the following, assuming the findin...
Treatment
...eatment...
...ctive Treatments...
...nds that all SLE patients with nephriti...
...tients with proteinuria ≥0.5 gm per 2...
...e ACR recommends that careful attention be paid t...
...ecommends that statin therapy be introduced in...
...recommends that women of child-bearing...
...for Induction of Improvement in Pa...
...he ACR recommends mycophenolate mofetil (MMF) (2...
...s, as compared to non-Asians, might require...
...ecommends that MMF and MPA are likely to be equiv...
.... low-dose “Euro-Lupus” CYC (500 mg IV o...
...high-dose CYC (500–1,000 mg/m2 IV once a mo...
...s being considered for treatment, the ACR...
...orticoids (500–1,000 mg methylprednisolon...
...nds that most patients be followed for 6 months af...
...recommends that MMF was preferable to CYC for pa...
...for Induction of Improvement in Patients With Clas...
...ACR recommends either CYC or MMF for...
...Recommendations for Induction of Impro...
...ACR recommends that patients with pure...
...tions for Maintaining Improvement...
...he ACR recommends that either AZA or MMF be used f...
...s for Changing Therapies in Patients W...
...who fail to respond after 6 months of trea...
...ted that in some cases rituximab can...
...nephritis is worsening in patients tre...
...recommends that thrombotic microangiopathy be tr...
...N in Patients Who Are Pregnant...
...with prior LN but no current evid...
...h mild systemic activity may be treated with HCQ;...
...ally active nephritis is present, or there is...
...patients with a persistently active nephriti...
Monitoring Activi...
...ations for monitoring LN are shown in Table...
...ss III/IV Induction Therapy...
...ent of Class III, IV, and V in Patients Who Are Pr...
.... Treatment of Class V with Proteinuria ≥3g/...
...3. Recommended Monitoring of Lupus Nephritis (mo...