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lupus nephritis guidelines

A Kaul, V Agrawal, D Bhaduaria, Vikas Agrawal, Narayan Prasad, Amit Gupta, R K Sharma
More than 50% of patients with systemic lupus erythematosus (SLE) have renal involvement at presentation or during their illness. Lupus nephritis (LN) encompasses several patterns of renal disease, including glomerular, tubulointerstitial, and vascular pathologies. The presence and significance of renal vascular lesions (VLs) are often overlooked. VLs in LN are not rare with an incidence of 10%-40% on renal biopsies from various studies and their presence is often labeled as poor prognostic markers. The current treatment protocol for LN is mainly based on the glomerular pathology, and no guidelines/consensus exists for treatment of LN with VLs...
March 2017: Saudi Journal of Kidney Diseases and Transplantation
Lei Zhang, Jianling Tao, Yubing Wen, Li Li, Xueyi Wu, Xuewang Li, Xuemei Li
To better clarify the clinical features and therapeutic strategy of CMV infection in lupus nephritis patients, we retrospectively surveyed a total of 40 lupus nephritis patients, who had been hospitalized and underwent renal biopsy and diagnosed as having CMV infection during their hospitalization at our institution within the last 10 years. The percentage of CMV infections in the entire hospitalized lupus nephritis population was 5.3% (40/755). The principal clinical features of the 40 CMV-infected patients were hematological disorders (n = 25), fever (n = 21), liver dysfunction (n = 19), and respiratory symptoms (n = 12)...
February 17, 2017: Clinical and Experimental Medicine
Scott E Wenderfer, Natasha M Ruth, Hermine I Brunner
The care of children with lupus nephritis (LN) has changed dramatically over the past 50 y. The majority of patients with childhood-onset systemic lupus erythematosus (cSLE) develop LN. In the 1960's, prognosis in children was worse than in adults; therapies were limited and toxic. Nearly half of cases resulted in death within 2 y. Since this time, several diagnostic recommendations and disease-specific indices have been developed to assist physicians caring for patients with LN. Pediatric researchers are validating and adapting these indices and guidelines for the treatment of LN in cSLE...
March 2017: Pediatric Research
Jasvinder A Singh, Alomgir Hossain, Ahmed Kotb, George Wells
BACKGROUND: To perform a systematic review and network meta-analysis (NMA) to compare the risk of serious infections with immunosuppressive medications and glucocorticoids in lupus nephritis. METHODS: A trained librarian performed two searches: (1) PubMed for all lupus nephritis trials from the end dates for the systematic review for the 2012 American College of Rheumatology (ACR) lupus nephritis treatment guidelines and the 2012 Cochrane Systematic Review on treatments for lupus nephritis, to September 2013; and (2) PubMed and SCOPUS for all lupus trials (excluding lupus nephritis) from inception to February 2014, to obtain additional trials for harms data in any lupus patient...
September 13, 2016: BMC Medicine
Melinda Zsuzsanna Szabó, Emese Kiss
The authors present the latest guideline for the treatment of lupus nephritis and their own single-centre results with mycofenolate mofetil treated lupus nephritis. Lupus nephritis and mainly its proliferative form is a frequent and potentially life-threatening manifestation of systemic lupus erythematosus that can lead to end-stage renal disease. The treatment of lupus nephritis greatly improved in the last decades; mycofenolate mofetil has become an alternative of cyclophosphamide both in remission induction and as a maintenance regimen as well in the treatment of Class III and IV glomerulonephritis...
August 2016: Orvosi Hetilap
Kentaro Minowa, Hirofumi Amano, Seiichiro Ando, Takashi Watanabe, Michihiro Ogasawara, Shinya Kawano, Toshiyuki Kaneko, Shinji Morimoto, Ken Yamaji, Naoto Tamura, Yoshiaki Tokano, Hiroshi Hashimoto, Yoshinari Takasaki
OBJECTIVE: To clarify the clinical features of systemic lupus erythematosus (SLE) patients, factors associated with flares, and changes over time. METHODS: Patients having SLE with a visiting history were entered into the Juntendo University Database of Erythematosus. We included 423 cases in the long-term follow-up analysis, and 383 cases were followed for 10 years after the initiation of any therapeutic intervention (comparative analysis: 1973-1982, 82 cases; 1983-1992, 141, and 1993-2002, 160)...
January 2017: Modern Rheumatology
Natasha Jordan, David D'Cruz
Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity...
2016: ImmunoTargets and Therapy
Paul J Hoover, Karen H Costenbader
Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that disproportionately affects nonwhites and those in lower socioeconomic groups. This review discusses recent data on the incidence, prevalence, and outcomes of patients with lupus nephritis with a focus on low-income US Medicaid patients. We also review recent guidelines on diagnosis, treatment, and screening for new onset and relapses of lupus nephritis. Finally, we discuss the management of lupus nephritis from a rheumatologist's perspective, including vigilance for the common adverse events related to disease and treatment, and we review prevention and new treatment strategies...
September 2016: Kidney International
Colin Thorbinson, Louise Oni, Eve Smith, Angela Midgley, Michael W Beresford
Systemic lupus erythematosus (SLE) is a rare, severe, multisystem autoimmune disorder. Childhood-onset SLE (cSLE) follows a more aggressive course with greater associated morbidity and mortality than adult-onset SLE. Its aetiology is yet to be fully elucidated. It is recognised to be the archetypal systemic autoimmune disease, arising from a complex interaction between the innate and adaptive immune systems. Its complexity is reflected by the fact that there has been only one new drug licensed for use in SLE in the last 50 years...
June 2016: Paediatric Drugs
Bethany J Wolf, John C Spainhour, John M Arthur, Michael G Janech, Michelle Petri, Jim C Oates
OBJECTIVE: The American College of Rheumatology guidelines for the treatment of lupus nephritis recommend change in induction therapy when response to therapy has not occurred within 6 months. Response is not defined, and renal fibrosis can occur while waiting for this end point. Therefore, a decision support tool to better define response is needed to guide clinicians when starting patients on therapy. This study was undertaken to identify biomarker models with sufficient predictive power to develop such a tool...
August 2016: Arthritis & Rheumatology
Marie-Angélique De Scheerder, O Boey, E Mahieu, J Vanuytsel, Anne-Marie Bogaert
We describe the case of a 26-year-old African female who was treated successfully with belimumab in a case of severe membranous lupus nephritis and retinal vasculitis, resistant to first line therapy. She presented initially with chronic dacryoadenitis and screening showed nephrotic-range proteinuria. Biopsy of the kidney confirmed the diagnosis of membranous lupus nephritis. Clinical features (joint pain, dacryoadenitis, retinal vasculitis and lupus nephritis) in combination with serology (positive anti-double-stranded DNA (ds-DNA) antibodies, hypocomplementemia) confirmed the diagnosis of systemic lupus erythematosus (SLE)...
June 2016: Clinical Rheumatology
Sanjeev Sethi, Mark Haas, Glen S Markowitz, Vivette D D'Agati, Helmut G Rennke, J Charles Jennette, Ingeborg M Bajema, Charles E Alpers, Anthony Chang, Lynn D Cornell, Fernando G Cosio, Agnes B Fogo, Richard J Glassock, Sundaram Hariharan, Neeraja Kambham, Donna J Lager, Nelson Leung, Michael Mengel, Karl A Nath, Ian S Roberts, Brad H Rovin, Surya V Seshan, Richard J H Smith, Patrick D Walker, Christopher G Winearls, Gerald B Appel, Mariam P Alexander, Daniel C Cattran, Carmen Avila Casado, H Terence Cook, An S De Vriese, Jai Radhakrishnan, Lorraine C Racusen, Pierre Ronco, Fernando C Fervenza
Renal pathologists and nephrologists met on February 20, 2015 to establish an etiology/pathogenesis-based system for classification and diagnosis of GN, with a major aim of standardizing the kidney biopsy report of GN. On the basis of etiology/pathogenesis, GN is classified into the following five pathogenic types, each with specific disease entities: immune-complex GN, pauci-immune GN, antiglomerular basement membrane GN, monoclonal Ig GN, and C3 glomerulopathy. The pathogenesis-based classification forms the basis of the kidney biopsy report...
May 2016: Journal of the American Society of Nephrology: JASN
Kamal V Kanodia, Aruna V Vanikar, Lovelesh K Nigam, Rashmi D Patel, Kamlesh S Suthar, Dinesh N Gera, Hargovind L Trivedi
BACKGROUND: Renal biopsy is a well-established diagnostic modality for the assessment of kidney diseases in children. It can provide diagnostic precision and prognostic value and guide in therapeutic options for many renal diseases. OBJECTIVES: This report describes the indication, histopathological patterns, and epidemiology of renal diseases in children in India. PATIENTS AND METHODS: This is a single-center study on renal biopsies performed between January 2008 and December 2013 in 346 children (age ≤ 14 years)...
July 2015: Nephro-urology Monthly
Lucy Croyle, Alberta Hoi, Eric F Morand
OBJECTIVE: Guidelines for azathioprine (AZA) use in systemic lupus erythematosus (SLE), including indications for initiation and cessation, are lacking. Clinical decision-making could be improved if reasons for cessation of AZA treatment were standardised. METHODS: We determined the characteristics of AZA use in a cohort of patients with SLE and evaluated reasons for AZA cessation. Patients with SLE in a single centre had longitudinal recording of disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI)-2k), laboratory investigations and treatment from 2007 to 2012...
2015: Lupus Science & Medicine
Annegret Kuhn, Gisela Bonsmann, Hans-Joachim Anders, Peter Herzer, Klaus Tenbrock, Matthias Schneider
BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease with a prevalence of 36.7/100 000 in Germany and a female/male ratio of 4:1. The clinical course is variable, with a broad spectrum of organ manifestations; lupus nephritis develops in about half of all patients. METHODS: This review is based on a selective search of PubMed and the Cochrane Library, including current guidelines and expert recommendations. RESULTS: Assessment of clinical symptoms, laboratory findings, and optional biopsy results are the basis for early diagnosis of SLE...
June 19, 2015: Deutsches Ärzteblatt International
Maria Guedes Marques, Patrícia Cotovio, Francisco Ferrer, Cristina Silva, Carlos Botelho, Karina Lopes, Pedro Maia, Armando Carreira, Mário Campos
BACKGROUND: Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE) that can lead to end-stage renal disease. According to the Kidney Disease Outcomes Global Improving clinical Guidelines for Glomerulonephritis, spot urine protein/creatinine (P/C) ratio should be used for monitoring LN. However, some reports write that the random spot urine P/C ratio is unreliable in monitoring proteinuria in SLE glomerulonephritis patients. The aim of this study was to evaluate the agreement of these two assay methods...
December 2013: Clinical Kidney Journal
Marianne Frieri, William Heuser, Joshua Bliss
Recently introduced into the market, belimumab (Benlysta) is a monoclonal antibody that has potential clinically efficacious applications for the treatment of lupus nephritis. Lupus nephritis is a major complication of systemic lupus erythematosus (SLE) that can lead to significant illness or even death without proper intervention and treatment. With vast implications through a novel mechanism, belimumab offers a new standard of treatment for physicians in the complications associated with SLE, specifically lupus nephritis...
April 2015: Journal of Pharmacology & Pharmacotherapeutics
Suzanne Wilhelmus, Ingeborg M Bajema, George K Bertsias, Dimitrios T Boumpas, Caroline Gordon, Liz Lightstone, Vladimir Tesar, David R Jayne
In the past years, many (randomized) trials have been performed comparing the treatment strategies for lupus nephritis. In 2012, these data were incorporated in six different guidelines for treating lupus nephritis. These guidelines are European, American and internationally based, with one separate guideline for children. They offer information on different aspects of the management of lupus nephritis including induction and maintenance treatment of the different histological classes, adjunctive treatment, monitoring of the patient, definitions of response and relapse, indications for (repeat) renal biopsy, and additional challenges such as the presence of vascular complications, the pregnant SLE patient, treatment in children and adolescents and considerations about end-stage renal disease and transplantation...
June 2016: Nephrology, Dialysis, Transplantation
David J Tunnicliffe, Davinder Singh-Grewal, Siah Kim, Jonathan C Craig, Allison Tong
OBJECTIVE: Management of systemic lupus erythematosus (SLE) is complex and variability in practices exists. Guidelines have been developed to help improve the management of SLE patients, but there has been no formal evaluation of these guidelines. This study aims to compare the scope, quality, and consistency of clinical practice guidelines on the diagnosis, monitoring, and treatment of patients with SLE. METHODS: Electronic databases were searched up to April 2014...
October 2015: Arthritis Care & Research
Manish Rathi, Krishan Lal Gupta, Kusum Joshi, Pramod K Gupta, Aman Sharma, Harbir Singh Kohli, Vivekanand Jha, Vinay Sakhuja
Current management guidelines for lupus nephritis (LN) do not attach importance to histological indices of disease activity or chronicity. The present study was performed to evaluate the clinical relevance of these indices in determining outcomes in patients with class IV LN. We analyzed the data of all patients with biopsy-proven class IV LN seen over a 6-year period. The histopathological findings were reviewed; the activity and chronicity indices proposed by Austin [AI (Austin) & CI (Austin)] and the renal biopsy index proposed by Hill were calculated...
September 2015: Rheumatology International
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