RT Journal Article
SR Electronic
T1 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
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1771
OP 1782
DO 10.1136/annrheumdis-2012-201940
VO 71
IS 11
A1 Bertsias, George K
A1 Tektonidou, Maria
A1 Amoura, Zahir
A1 Aringer, Martin
A1 Bajema, Ingeborg
A1 Berden, Jo H M
A1 Boletis, John
A1 Cervera, Ricard
A1 Dörner, Thomas
A1 Doria, Andrea
A1 Ferrario, Franco
A1 Floege, Jürgen
A1 Houssiau, Frederic A
A1 Ioannidis, John P A
A1 Isenberg, David A
A1 Kallenberg, Cees G M
A1 Lightstone, Liz
A1 Marks, Stephen D
A1 Martini, Alberto
A1 Moroni, Gabriela
A1 Neumann, Irmgard
A1 Praga, Manuel
A1 Schneider, Matthias
A1 Starra, Argyre
A1 Tesar, Vladimir
A1 Vasconcelos, Carlos
A1 van Vollenhoven, Ronald F
A1 Zakharova, Helena
A1 Haubitz, Marion
A1 Gordon, Caroline
A1 Jayne, David
A1 Boumpas, Dimitrios T
YR 2012
UL http://ard.bmj.com/content/71/11/1771.abstract
AB Objectives To develop recommendations for the management of adult and paediatric lupus nephritis (LN). Methods 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. Results 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. Conclusions Recommendations for the management of LN were developed using an evidence-based approach followed by expert consensus.