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2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis.
Fanouriakis, Antonis; Kostopoulou, Myrto; Cheema, Kim; Anders, Hans-Joachim; Aringer, Martin; Bajema, Ingeborg; Boletis, John; Frangou, Eleni; Houssiau, Frederic A; Hollis, Jane; Karras, Adexandre; Marchiori, Francesca; Marks, Stephen D; Moroni, Gabriella; Mosca, Marta; Parodis, Ioannis; Praga, Manuel; Schneider, Matthias; Smolen, Josef S; Tesar, Vladimir; Trachana, Maria; van Vollenhoven, Ronald F; Voskuyl, Alexandre E; Teng, Y K Onno; van Leew, Bernadette; Bertsias, George; Jayne, David; Boumpas, Dimitrios T.
Afiliação
  • Fanouriakis A; Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, Athens, Greece.
  • Kostopoulou M; Department of Rheumatology, "Asklepieion" General Hospital, Athens, Greece.
  • Cheema K; Department of Nephrology, "G. Gennimatas" General Hospital, Athens, Greece.
  • Anders HJ; Department of Medicine, Cambridge University, Cambridge, UK.
  • Aringer M; Division of Nephrology, Department of Medicine IV, University Hospital LMU Munich, Munich, Germany.
  • Bajema I; Division of Rheumatology, Department of Medicine III, University Medical Center & Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany.
  • Boletis J; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
  • Frangou E; Nephrology Department and Renal Transplantation Unit, "Laikon" Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
  • Houssiau FA; Department of Nephrology, Limassol General Hospital, Limassol, Cyprus.
  • Hollis J; Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
  • Karras A; Lupus nurse specialist, Addenbrooke's Hospital, Cambridge, UK.
  • Marchiori F; Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Marks SD; Lupus Europe, Rome, Italy.
  • Moroni G; University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
  • Mosca M; Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Parodis I; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
  • Praga M; Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
  • Schneider M; Nephrology Department, Research Institute Hospital Universitario 12 de Octubre (i+12), Department of Medicine, Complutense University of Madrid, Madrid, Spain.
  • Smolen JS; Department of Rheumatology & Hiller Research Unit Rheumatology, UKD, Heinrich-Heine University, Duesseldorf, Germany.
  • Tesar V; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
  • Trachana M; Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
  • van Vollenhoven RF; Pediatric Immunology and Rheumatology Referral Center, First Pediatric Clinic, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
  • Voskuyl AE; Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
  • Teng YKO; Rheumatology and Immunology Center, Amsterdam University Medical Center, Amsterdam, The Netherlands.
  • van Leew B; Centre of expertise for Lupus-, Vasculitis- and Complement-mediated Systemic autoimmune diseases, Department of Internal Medicine - section Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
  • Bertsias G; Lupus Europe, Essex, UK.
  • Jayne D; Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece.
  • Boumpas DT; Department of Medicine, Cambridge University, Cambridge, UK.
Ann Rheum Dis ; 79(6): 713-723, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32220834
ABSTRACT

OBJECTIVE:

To update the 2012 EULAR/ERA-EDTA recommendations for the management of lupus nephritis (LN).

METHODS:

Following the EULAR standardised operating procedures, a systematic literature review was performed. Members of a multidisciplinary Task Force voted independently on their level of agreeement with the formed statements.

RESULTS:

The changes include recommendations for treatment targets, use of glucocorticoids and calcineurin inhibitors (CNIs) and management of end-stage kidney disease (ESKD). The target of therapy is complete response (proteinuria <0.5-0.7 g/24 hours with (near-)normal glomerular filtration rate) by 12 months, but this can be extended in patients with baseline nephrotic-range proteinuria. Hydroxychloroquine is recommended with regular ophthalmological monitoring. In active proliferative LN, initial (induction) treatment with mycophenolate mofetil (MMF 2-3 g/day or mycophenolic acid (MPA) at equivalent dose) or low-dose intravenous cyclophosphamide (CY; 500 mg × 6 biweekly doses), both combined with glucocorticoids (pulses of intravenous methylprednisolone, then oral prednisone 0.3-0.5 mg/kg/day) is recommended. MMF/CNI (especially tacrolimus) combination and high-dose CY are alternatives, for patients with nephrotic-range proteinuria and adverse prognostic factors. Subsequent long-term maintenance treatment with MMF or azathioprine should follow, with no or low-dose (<7.5 mg/day) glucocorticoids. The choice of agent depends on the initial regimen and plans for pregnancy. In non-responding disease, switch of induction regimens or rituximab are recommended. In pure membranous LN with nephrotic-range proteinuria or proteinuria >1 g/24 hours despite renin-angiotensin-aldosterone blockade, MMF in combination with glucocorticoids is preferred. Assessment for kidney and extra-renal disease activity, and management of comorbidities is lifelong with repeat kidney biopsy in cases of incomplete response or nephritic flares. In ESKD, transplantation is the preferred kidney replacement option with immunosuppression guided by transplant protocols and/or extra-renal manifestations. Treatment of LN in children follows the same principles as adult disease.

CONCLUSIONS:

We have updated the EULAR recommendations for the management of LN to facilitate homogenization of patient care.
Assuntos
Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Sociedades Médicas / Nefrite Lúpica / Imunossupressores Tipo de estudo: Estudo de etiologia / Guia de prática clínica / Estudo prognóstico / Fatores de risco Limite: Humanos País/Região como assunto: Europa Idioma: Inglês Revista: Ann Rheum Dis Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Grécia

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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Sociedades Médicas / Nefrite Lúpica / Imunossupressores Tipo de estudo: Estudo de etiologia / Guia de prática clínica / Estudo prognóstico / Fatores de risco Limite: Humanos País/Região como assunto: Europa Idioma: Inglês Revista: Ann Rheum Dis Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Grécia