Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis.
Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis.
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DOI：
10.1136/annrheumdis-2012-201940
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发表时间：
2012-11
影响因子：
27.4
通讯作者：
European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association
中科院分区：
文献类型：
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作者：
Bertsias GK;Tektonidou M;Amoura Z;Aringer M;Bajema I;Berden JH;Boletis J;Cervera R;Dörner T;Doria A;Ferrario F;Floege J;Houssiau FA;Ioannidis JP;Isenberg DA;Kallenberg CG;Lightstone L;Marks SD;Martini A;Moroni G;Neumann I;Praga M;Schneider M;Starra A;Tesar V;Vasconcelos C;van Vollenhoven RF;Zakharova H;Haubitz M;Gordon C;Jayne D;Boumpas DT;European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association
制定成人和儿童狼疮性肾炎（LN）的管理建议。使用PubMed数据库对现有证据进行了系统性审查。采用改进的德尔菲法编制问题，征求专家意见，达成共识。免疫抑制治疗应在肾活检指导下进行，目标是完全肾反应（蛋白尿<0.5 g/24 h，肾功能正常或接近正常）。 羟氯喹推荐用于所有LN患者。由于更有利的疗效/毒性比，作为根据国际肾脏病学会/肾脏病理学会2003分类的III-IVA或A/C（±V）LN患者的初始治疗，推荐霉酚酸（MPA）或低剂量静脉环磷酰胺（CY）联合糖皮质激素。在具有不良临床或组织学特征的患者中，CY可以以更高的剂量处方，而硫唑嘌呤是轻度病例的替代品。对于伴有肾病范围蛋白尿的单纯V类LN，推荐MPA联合口服糖皮质激素作为初始治疗。在初始治疗后改善的患者中，建议使用MPA或硫唑嘌呤进行后续免疫抑制至少3年;在这种情况下，MPA初始治疗后应使用MPA。 对于MPA或CY失败，切换到其他代理，或利妥昔单抗，是建议的行动过程。在怀孕的预期中，患者应改用适当的药物，而不降低治疗强度。没有证据表明LN的治疗在儿童和成人中应该有所不同。LN的管理建议采用循证方法，然后由专家达成共识。
To develop recommendations for the management of adult and paediatric lupus nephritis (LN). The available evidence was systematically reviewed using the PubMed database. A modified Delphi method was used to compile questions, elicit expert opinions and reach consensus. Immunosuppressive treatment should be guided by renal biopsy, and aiming for complete renal response (proteinuria <0.5 g/24 h with normal or near-normal renal function). Hydroxychloroquine is recommended for all patients with LN. Because of a more favourable efficacy/toxicity ratio, as initial treatment for patients with class III–IVA or A/C (±V) LN according to the International Society of Nephrology/Renal Pathology Society 2003 classification, mycophenolic acid (MPA) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. In patients with adverse clinical or histological features, CY can be prescribed at higher doses, while azathioprine is an alternative for milder cases. For pure class V LN with nephrotic-range proteinuria, MPA in combination with oral glucocorticoids is recommended as initial treatment. In patients improving after initial treatment, subsequent immunosuppression with MPA or azathioprine is recommended for at least 3 years; in such cases, initial treatment with MPA should be followed by MPA. For MPA or CY failures, switching to the other agent, or to rituximab, is the suggested course of action. In anticipation of pregnancy, patients should be switched to appropriate medications without reducing the intensity of treatment. There is no evidence to suggest that management of LN should differ in children versus adults. Recommendations for the management of LN were developed using an evidence-based approach followed by expert consensus.
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