Immunosuppressive treatment for proliferative lupus nephritis

Tunnicliffe, David J.; Palmer, Suetonia C.; Henderson, Lorna; Masson, Philip; Craig, Jonathan C.; Tong, Allison; Singh‐Grewal, Davinder; Flanc, Robert S; Roberts, Matthew A; Webster, Angela C; Strippoli, Giovanni F.M.

doi:10.1002/14651858.cd002922.pub4

Cited by 69 publications

(109 citation statements)

References 193 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In class III-IV LN, an updated Cochrane systematic review suggested similar efficacy of mycophenolate mofetil/mycophenolate acid (MMF/MPA) compared with cyclophosphamide (CY), 33 with possible ethnic/racial differences, that is, MMF potentially being more efficacious in African-Americans. 34 The 10-year Euro-Lupus Nephritis Trial data showed equal efficacy of low-dose versus high-dose CY, 24 and the low-dose regimen has been used in non-European populations.…”

Section: Initial Treatmentmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

ObjectiveTo update the 2012 EULAR/ERA–EDTA recommendations for the management of lupus nephritis (LN).MethodsFollowing the EULAR standardised operating procedures, a systematic literature review was performed. Members of a multidisciplinary Task Force voted independently on their level of agreeement with the formed statements.ResultsThe changes include recommendations for treatment targets, use of glucocorticoids and calcineurin inhibitors (CNIs) and management of end-stage kidney disease (ESKD). The target of therapy is complete response (proteinuria <0.5–0.7 g/24 hours 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 2–3 g/day or mycophenolic acid (MPA) at equivalent dose) or low-dose intravenous cyclophosphamide (CY; 500 mg × 6 biweekly doses), both combined with glucocorticoids (pulses of intravenous methylprednisolone, then oral prednisone 0.3–0.5 mg/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 >1 g/24 hours 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 kidney biopsy in cases of incomplete response or nephritic flares. In ESKD, transplantation is the preferred kidney replacement option with immunosuppression guided by transplant protocols and/or extra-renal manifestations. Treatment of LN in children follows the same principles as adult disease.ConclusionsWe have updated the EULAR recommendations for the management of LN to facilitate homogenization of patient care.

show abstract

Section: Initial Treatmentmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, recent emerging evidence suggest adding mycophenolate mofetil to patients with lupus nephritis is superior to IV cyclophosphamide. 11 Early diagnosis of SLE is the key to optimum management and better outcome of the patient, because juvenile SLE has more aggressive disease course, greater morbidity and mortality than adult onset disease. 10 Diffuse lymphadenopathy as the presenting symptom of SLE is not common today, however it should not be forgotten as in our case to avoid delay in making the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Systemic Lupus Erythematosus mimicking lymphoproliferative malignancy in a child

Munasinghe

Naotunna

Vithana

et al. 2019

J. Ruhunu Clin. Soc.

View full text Add to dashboard Cite

Systemic Lupus Erythematosus (SLE) is a chromic autoimmune disease with multisystemic involvement. The estimated prevalence of SLE among children is 1-6/100000. Here we report a child who presented with generalized lymphadeopathy as the first manifestation of SLE. A 13 year old previously healthy girl presented with cervical lymphadenopathy and low grade remitting fever for 1 month duration. On examination she was found to have generalized lymphadenopathy and unremarkable rest of the clinical examination. Her basic haematological and biochemical parameters were normal. ESR was 110mm/hr and CRP was 6mg/dL. Ultrasound scan and Contrast CT of the abdomen and pelvis revealed extensive mediastinal, mesenteric, para-aortic, splenic hilar, bilateral axillary and inguinal lymphadenopathy suggestive of lymphoproliferative malignancy. However, her bone marrow and lymph node biopsies revealed reactive pattern. Meantime she developed a malar rash, oral ulcers and 2 episodes of generalized tonic-clonic convulsions. Her urinalysis revealed microscopic haematuria and sub nephrotic range proteinuria. Her ANA and dsDNA levels were positive. Her subsequent full blood count revealed severe bicytopenia, predominetly lymphopenia.The diagnosis of SLE was made and she was started on Hydroxychloroquine, high dose prednisolone and cyclophosphamide pulse therapy. The most common presenting symptoms of SLE in children include, constituitional symptoms, joint symptoms and haematological abnormalities. It is estimated 23-34% children with SLE are having lymphadenopathy. Though, generalized lymphadenopathy as the presenting symptom of SLE is uncommon, it should not be forgotten in order to avoid diagnostic delay.

show abstract

“…In other words, it may be easier to overlook hyperuricemia in female kidney transplant recipients. In addition, many patients with lupus nephritis tend to be women and these patients are prescribed MMF and corticosteroids for their condition [23]. Patients with these conditions greatly resemble kidney transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in uric acid levels in kidney transplant recipients and their donors: a preliminary retrospective cross-sectional study

et al. 2019

View full text Add to dashboard Cite

Background: Higher serum uric acid (UA) levels are associated with poorer renal prognosis. In kidney transplantation, both donors and recipients are diagnosed as having chronic kidney diseases (CKD) based on renal function; however, their UA levels slightly vary. Elucidating the differences in UA would help improve kidney prognosis, especially for recipients. Therefore, we investigated UA levels in kidney transplant recipients by comparing them to those in their donors. Methods: In this retrospective cross-sectional survey, background information and blood examination results were collected from the donors just before donation and after transplantation in the donors and recipients. Associations between UA and sex estimated glomerular filtration rate (eGFR), and body mass index (BMI) were evaluated. Data were assessed by the Wilcoxon rank-sum test for continuous variables and the chi-squared test for categorical variables; multiple linear regression analyses were performed to determine which factors were associated with renal function before and after transplantation. Results: Participant characteristics were as follows. The mean donor age (n = 45, 16 men and 29 women) was 55 ± 11 years, and the mean recipient age (n = 45, 25 men and 20 women) was 46 ± 16 years. Sex-related differences (UA levels in men were predominant) existed in the UA of donors before (P < 0.001) and after donation (P < 0.001). Conversely, there were no significant sex-related differences in the UA of recipients (P = 0.51); the mean standardized eGFRs were similar in donors and recipients after transplantation. Multivariate linear regression analysis showed donor UA only correlated with donor sex before donation (P = 0.008). After donation, donor UA was associated with donor sex (P = 0.006), eGFR (P < 0.001), and BMI (P = 0.02). Notably, the UA of recipients after transplantation was only associated with eGFR (P = 0.003). Conclusions: Sex has less impact on UA in recipients than in donors. UA has a greater impact on renal prognosis in women than men, even at the same UA level. Therefore, attention should be given to UA levels in female recipients. These findings can be useful for determining patient prognosis following kidney transplantation in both donors and recipients.

show abstract

Immunosuppressive treatment for proliferative lupus nephritis

Cited by 69 publications

References 193 publications

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

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

Systemic Lupus Erythematosus mimicking lymphoproliferative malignancy in a child

Sex differences in uric acid levels in kidney transplant recipients and their donors: a preliminary retrospective cross-sectional study

Contact Info

Product

Resources

About