Ten Common Mistakes in the Management of Lupus Nephritis

Bose, Bhadran; Silverman, Earl D.; Bargman, Joanne M.

doi:10.1053/j.ajkd.2013.10.056

Cited by 37 publications

(28 citation statements)

References 58 publications

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“…Also, potential barriers to guideline implementation were not identified in most guidelines. To assess barriers, we suggest using the National Institute for Clinical Studies barrier tool (28) or Barriers Identification and Mitigation tool (29). Furthermore, criteria and frequency for auditing should be provided; for example, lupus nephritis guidelines could suggest collecting data on the indication for renal biopsy for on-going audit.…”

Section: Discussionmentioning

confidence: 99%

“…Rates of nonadherence in SLE have been reported as high as 76% (43) and are associated with a higher risk of flare, morbidity, hospitalization, and poor renal outcome (44). Nonadherence to therapy as a cause of treatment failure is commonly seen in clinical practice (28) and may affect therapeutic decisions. Addressing the issue of adherence is likely to be an important part of optimizing outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines

Tunnicliffe

Singh‐Grewal

Kim

et al. 2015

Arthritis Care & Research

125

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Objective. Management of systemic lupus erythematosus (SLE) is complex and variability in practices exists. Guidelines have been developed to help improve the management of SLE patients, but there has been no formal evaluation of these guidelines. This study aims to compare the scope, quality, and consistency of clinical practice guidelines on the diagnosis, monitoring, and treatment of patients with SLE. Methods. Electronic databases were searched up to April 2014. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument and textual synthesis was used to appraise and compare recommendations. Results. Nine clinical practice guidelines and 5 consensus statements were identified, which covered 7 topics: diagnosis, monitoring, treatment, neuropsychiatric SLE, lupus nephritis, antiphospholipid syndrome, and other manifestations of lupus. The methodological quality of the guidelines was variable, with the overall mean AGREE II scores ranging from 31% to 75%, out of a maximum 100%. Scores were consistently low for applicability, with only 1 guideline scoring above 50%. There was substantial variability in the treatments recommended for class II and V lupus nephritis, the recommended duration of maintenance therapy for class III/IV lupus nephritis (from 1 to 4 years), and timing of ophthalmologic examination for patients taking corticosteroids. Conclusion. Published guidelines on SLE cover a complex area of clinical care, but the methodological quality, scope, and recommendations varied substantially. Collaborative and multidisciplinary efforts to develop comprehensive, highquality evidence-based guidelines are needed to promote best treatment and health outcomes for patients with SLE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines

Tunnicliffe

Singh‐Grewal

Kim

et al. 2015

Arthritis Care & Research

125

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“…Indeed, glucocorticoid-induced damage is frequently viewed as the inevitable price to pay for controlling lupus activity and avoiding damage accrual due to lupus [19]. However, no solid data support this approach [20].…”

Section: Discussionmentioning

confidence: 99%

“…mg/day, and maximum dose 63.5(19) mg/day, vs. mean (SD) total amount 1550 (1202) mg, mean (SD) average dose 4 (3) md/day and mean (SD) maximum dose 11 (10) mg/day in patients of group M (p b 0.001 for all comparisons) (Table 2). Likewise, 29/30 (97%) patients in group H received an average dose of prednisone N7.5 mg/day during the first year, vs. 6/30 (20%) patients in group M (p b 0.001).…”

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confidence: 97%

Comparison of high versus low–medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis

Ruiz-Arruza

Barbosa

Ugarte

et al. 2015

Autoimmunity Reviews

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“…Therefore, a definition of refractory disease has been proposed and can be applied in future studies [16]. Finally, hematuria and red cell casts are not considered to be criteria for response in LN for several reasons, as recently reported by Bose et al [17]. Nevertheless, and although our investigation is neither controlled nor prospective, our findings do provide valuable data on the role of MF in uncontrolled LN in a representative Spanish population.…”

Section: Discussionmentioning

confidence: 84%

Mycophenolate in Refractory and Relapsing Lupus Nephritis

Rivera

Mérida²,

Illescas³

et al. 2014

Am J Nephrol

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Background: Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN. Methods: Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects. Results: The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage. Conclusions: Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN.

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Ten Common Mistakes in the Management of Lupus Nephritis

Cited by 37 publications

References 58 publications

Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines

Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines

Comparison of high versus low–medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis

Mycophenolate in Refractory and Relapsing Lupus Nephritis

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