TY - JOUR 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 SP - 1771 LP - 1782 DO - 10.1136/annrheumdis-2012-201940 VL - 71 IS - 11 AU - George K Bertsias AU - Maria Tektonidou AU - Zahir Amoura AU - Martin Aringer AU - Ingeborg Bajema AU - Jo H M Berden AU - John Boletis AU - Ricard Cervera AU - Thomas Dörner AU - Andrea Doria AU - Franco Ferrario AU - Jürgen Floege AU - Frederic A Houssiau AU - John P A Ioannidis AU - David A Isenberg AU - Cees G M Kallenberg AU - Liz Lightstone AU - Stephen D Marks AU - Alberto Martini AU - Gabriela Moroni AU - Irmgard Neumann AU - Manuel Praga AU - Matthias Schneider AU - Argyre Starra AU - Vladimir Tesar AU - Carlos Vasconcelos AU - Ronald F van Vollenhoven AU - Helena Zakharova AU - Marion Haubitz AU - Caroline Gordon AU - David Jayne AU - Dimitrios T Boumpas Y1 - 2012/11/01 UR - http://ard.bmj.com/content/71/11/1771.abstract N2 - 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. ER -