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OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis
  1. G. Bertsias1,
  2. M. Tektonidou2,
  3. Z. Amoura3,
  4. M. Aringer4,
  5. I. Bajema5,
  6. J. Berden6,
  7. J. Boletis7,
  8. R. Cervera8,
  9. T. Dörner9,
  10. A. Doria10,
  11. F. Ferrario11,
  12. J. Flöge12,
  13. F. Houssiau13,
  14. J.P. Ioannidis14,
  15. D. Isenberg15,
  16. C.G. Kallenberg16,
  17. L. Lightstone17,
  18. S. Marks18,
  19. A. Martini19,
  20. G. Moroni20,
  21. I. Neumann21,
  22. P. Niaudet22,
  23. M. Praga23,
  24. M. Schneider24,
  25. V. Tesar25,
  26. C. Vasconcelos26,
  27. R. van Vollenhoven27,
  28. E. Zakharova28,
  29. M. Haubitz29,
  30. C. Gordon30,
  31. D. Jayne31,
  32. D. Boumpas1
  1. 1University of Crete, Heraklion
  2. 2Rheumatology, University of Athens, Athens, Greece
  3. 3Hôpital Pitié-Salpêtrière, Paris, France
  4. 4Universitätsklinikum Carl Gustav Carus, Dresden, Germany
  5. 5Leiden University Medical Center, Leiden
  6. 6Ncmls, Nijmegen, Netherlands
  7. 7Laiko Hospital, Athens, Greece
  8. 8Universitat de Barcelona, Barcelona, Spain
  9. 9Charité - Universitätsmedizin Berlin, Berlin, Germany
  10. 10University of Padova, Padova
  11. 11San Carlo Borromeo Hospital and Fondazione, Milan, Italy
  12. 12University Hospital, Aachen, Germany
  13. 13Université catholique de Louvain, Brussels, Belgium
  14. 14Stanford University School of Medicine, Stanford, United States
  15. 15University College Hospital, London, United Kingdom
  16. 16University Hospital Groningen, Groningen, Netherlands
  17. 17Imperial College London
  18. 18University College London Institute of Child Health, London, United Kingdom
  19. 19University of Genoa, Genoa
  20. 20Fondazione Ospedale Maggiore Policlinco, Milan, Italy
  21. 21Fachärztin für Innere Medizin, Wien, Austria
  22. 22Hopital Necker Enfants Malades Tour Lavoisier, Paris, France
  23. 23Hospital 12 de Octubre, Madrid, Spain
  24. 24Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
  25. 25Charles University, Praque, Czech Republic
  26. 26Centro Hospitalar do Porto, Porto, Portugal
  27. 27Karolinska Institute, Stockholm, Sweden
  28. 28University of Moscow, Moscow, Russian Federation
  29. 29Medizinische Hochschule, Hannover, Germany
  30. 30University of Birmingham
  31. 31Cambridge University, London, United Kingdom

Abstract

Background There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN).

Objectives To develop recommendations for the management of LN.

Methods Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations.

Results No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class IIIA or A/C and Class IVA or A/C (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m2) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine <2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults.

Conclusions Recommendations for LN were developed using an evidence-based approach followed by expert consensus.

Disclosure of Interest None Declared

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