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Practice Guideline
. 2012 Nov;71(11):1771-82.
doi: 10.1136/annrheumdis-2012-201940. Epub 2012 Jul 31.

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

George K Bertsias  1 , Maria Tektonidou, Zahir Amoura, Martin Aringer, Ingeborg Bajema, Jo H M Berden, John Boletis, Ricard Cervera, Thomas Dörner, Andrea Doria, Franco Ferrario, Jürgen Floege, Frederic A Houssiau, John P A Ioannidis, David A Isenberg, Cees G M Kallenberg, Liz Lightstone, Stephen D Marks, Alberto Martini, Gabriela Moroni, Irmgard Neumann, Manuel Praga, Matthias Schneider, Argyre Starra, Vladimir Tesar, Carlos Vasconcelos, Ronald F van Vollenhoven, Helena Zakharova, Marion Haubitz, Caroline Gordon, David Jayne, Dimitrios T Boumpas; European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association
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Free PMC article
Practice Guideline

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

George K Bertsias et al. Ann Rheum Dis. 2012 Nov.
Free PMC article

Abstract

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-IV(A) 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.

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References

    1. Bertsias G, Ioannidis JP, Boletis J, et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 2008;67:195–205 - PubMed
    1. Dougados M, Betteridge N, Burmester GR, et al. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Ann Rheum Dis 2004;63:1172–6 - PMC - PubMed
    1. Appenzeller S, Clark A, Pineau C, et al. Isolated pyuria in systemic lupus erythematosus. Lupus 2010;19:793–6 - PubMed
    1. Rahman P, Gladman DD, Ibanez D, et al. Significance of isolated hematuria and isolated pyuria in systemic lupus erythematosus. Lupus 2001;10:418–23 - PubMed
    1. Leaker B, Fairley KF, Dowling J, et al. Lupus nephritis: clinical and pathological correlation. Q J Med 1987;62:163–79 - PubMed

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