Academic Journal
OP0163 2019 UPDATE OF THE JOINT EUROPEAN LEAGUE AGAINST RHEUMATISM AND EUROPEAN RENAL ASSOCIATION–EUROPEAN DIALYSIS AND TRANSPLANT ASSOCIATION (EULAR/ERA-EDTA) RECOMMENDATIONS FOR THE MANAGEMENT OF LUPUS NEPHRITIS
| العنوان: | OP0163 2019 UPDATE OF THE JOINT EUROPEAN LEAGUE AGAINST RHEUMATISM AND EUROPEAN RENAL ASSOCIATION–EUROPEAN DIALYSIS AND TRANSPLANT ASSOCIATION (EULAR/ERA-EDTA) RECOMMENDATIONS FOR THE MANAGEMENT OF LUPUS NEPHRITIS |
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| المؤلفون: | Fanouriakis, A., Kostopoulou, M., Cheema, K., Anders, H. J., Aringer, M., Bajema, I., Boletis, J. N., Frangou, E., Houssiau, F., Hollis, J., Karras, A., Marchiori, F., Marks, S., Moroni, G., Mosca, M., Parodis, I., Praga, M., Schneider, M., Smolen, J. S., Tesar, V., Trachana, M., Vollenhoven, R. V., Voskuyl, A., Teng, Y. K. O., Van Leeuw, B., Bertsias, G., Jayne, D., Boumpas, D. |
| سنة النشر: | 2021 |
| المجموعة: | Istituto Nazionale di Fisica Nucleare (INFN): Open Access Repository |
| مصطلحات موضوعية: | General Biochemistry, Genetics and Molecular Biology, Immunology, Immunology and Allergy, Rheumatology |
| الوصف: | Background:Up to 40% of systemic lupus erythematosus (SLE) patients develop kidney disease, which represents a major cause of morbidity.Objectives:To update the 2012 EULAR/ERA-EDTA recommendations for the management of lupus nephritis (LN).Methods:We followed the EULAR standardised operating procedures for the publication of treatment recommendations. Delphi-based methodology led to 15 questions for systematic literature review (SLR), which was undertaken by three fellows.Results:The changes include recommendations for treatment targets, use of glucocorticoids and calcineurin inhibitors (CNI), and management of end-stage-kidney-disease (ESKD). The target of therapy is complete response (proteinuria <0.5-0.7gr/24h with [near-]normal glomerular filtration rate) by 12 months, but this can be extended in patients with baseline nephrotic-range proteinuria. Hydroxychloroquine is recommended with regular ophthalmological monitoring. In active proliferative LN, initial (induction) treatment with mycophenolate mofetil (MMF 2-3g/day, or mycophenolic acid at equivalent dose) or low-dose intravenous cyclophosphamide (CY; 500mg x6 biweekly doses), both combined with glucocorticoids (pulses of intravenous methylprednisolone, then oral prednisone 0.3-0.5mg/kg/day) is recommended. MMF/CNI (especially tacrolimus) combination and high-dose CY are alternatives, for patients with nephrotic-range proteinuria and adverse prognostic factors. Subsequent long-term maintenance treatment with MMF or azathioprine should follow, with no or low-dose (<7.5 mg/day) glucocorticoids. The choice of agent depends on the initial regimen and plans for pregnancy. In non-responding disease, switch of induction regimens or rituximab are recommended. In pure membranous LN with nephrotic-range proteinuria or proteinuria >1g/24h despite renin-angiotensin-aldosterone blockade, MMF in combination with glucocorticoids is preferred. Assessment for kidney and extra-renal disease activity, and management of comorbidities is lifelong with repeat ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| Relation: | url:https://www.openaccessrepository.it/communities/itmirror; https://www.openaccessrepository.it/record/174576 |
| DOI: | 10.1136/annrheumdis-2020-eular.3870 |
| الاتاحة: | https://www.openaccessrepository.it/record/174576 https://doi.org/10.1136/annrheumdis-2020-eular.3870 |
| Rights: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.29198DCE |
| قاعدة البيانات: | BASE |
| DOI: | 10.1136/annrheumdis-2020-eular.3870 |
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