Treatment of proliferative glomerulonephritis of systemic lupus erythematosus. Recent development and current recommendations
Treatment of proliferative glomerulonephritis of systemic lupus erythematosus. Recent development and current recommendations
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DOI：
10.1016/j.revmed.2008.04.019
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发表时间：
2008-09-01
影响因子：
0.9
通讯作者：
Daugas, E.
中科院分区：
文献类型：
--
作者：
Daugas, E.
在系统性红斑狼疮的病程中，肾脏受累的发生率估计为40%。在超过一半的病例中，组织学评估导致诊断为严重肾小球肾炎（2003年ISN/RPS分类的III级或IV级a或a /C级），这需要低毒性的强效治疗，旨在缓解肾炎，预防复发，预防慢性肾衰竭和死亡。这篇综述集中在过去三十年中最重要的试验，这些试验逐渐描述了用于狼疮增生性肾小球肾炎活动性病变的治疗方案。治疗应包括诱导方案，然后是维持方案。到目前为止，标准的诱导方法是糖皮质激素和静脉注射环磷酰胺，维持最佳耐受性的最有效方案是低剂量糖皮质激素和硫唑嘌呤或霉酚酸酯联合使用。然而，环磷酰胺的使用受到其副作用的限制，应尽可能减少其累积剂量。当不考虑环磷酰胺诱导时，与类固醇相关的硫唑嘌呤或霉酚酸酯可作为替代方案。然而，在预防复发和长期维持肾功能方面，硫唑嘌呤似乎不如环磷酰胺有效。评估霉酚酸酯诱导的初步数据是有希望的，但需要进行试验来确定霉酚酸酯诱导是否可以达到这一目标。(C) 2008 Elsevier Masson SAS。我们的权利储备。
The prevalence of the renal involvement is estimated at 40% during the course of systemic lupus erythematosus. In more than half of cases, the histological evaluation leads to the diagnosis of a severe glomerulonephritis (class III or IV A or A/C of the 2003 ISN/RPS classification) which requires a powerful treatment aiming at the remission of the nephritis, at the prevention of relapses, and at the prevention of chronic renal failure and death, with low toxicity. This review focuses on the most important trials of the last three decades that progressively delineated the treatment regimens used for lupus proliferative glomerulonephritis with active lesions. The treatment should consist in an induction regimen followed by a maintenance regimen. Until now, the standard induction associates corticosteroids and intravenous cyclophosphamide, and the most efficient regimen for maintenance with the best tolerance profile is the association of low dose corticosteroids and azathioprine or mycophenolate mofetil. However, the use of cyclophosphamide is limited by its side effects and its cumulated dose should be reduced as much as possible. When cyclophosphamide is not considered for induction, azathioprine or mycophenolate mofetil associated with steroids may constitute an alternative regimen. However, azathioprine seems less effective than cyclophosphamide to prevent relapses and preserve the renal function on a long-term basis. Preliminary data evaluating induction with mycophenolate mofetil are promising, but ongoing trials are needed to determine if induction with mycophenolate mofetil could reach this goal. (C) 2008 Elsevier Masson SAS. Tous droits reserves.