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
AU - Bertsias, George K.
AU - Tektonidou, Maria
AU - Amoura, Zahir
AU - Aringer, Martin
AU - Bajema, Ingeborg
AU - Berden, Jo H. M.
AU - Boletis, John
AU - Cervera, Ricard
AU - Dörner, Thomas
AU - Doria, Andrea
AU - Ferrario, Franco
AU - Floege, Jürgen
AU - Houssiau, Frederic A.
AU - Ioannidis, John P. A.
AU - Isenberg, David A.
AU - Kallenberg, Cees G. M.
AU - Lightstone, Liz
AU - Marks, Stephen D.
AU - Martini, Alberto
AU - Moroni, Gabriela
AU - Neumann, Irmgard
AU - Praga, Manuel
AU - Schneider, Matthias
AU - Starra, Argyre
AU - Tesar, Vladimir
AU - Vasconcelos, Carlos
AU - van Vollenhoven, Ronald F.
AU - Zakharova, Helena
AU - Haubitz, Marion
AU - Gordon, Caroline
AU - Jayne, David
AU - Boumpas, Dimitrios T.
PY - 2012
Y1 - 2012
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
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
U2 - https://doi.org/10.1136/annrheumdis-2012-201940
DO - https://doi.org/10.1136/annrheumdis-2012-201940
M3 - Review article
C2 - 22851469
SN - 0003-4967
VL - 71
SP - 1771
EP - 1782
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 11
ER -