Update on Lupus Nephritis: Core Curriculum 2020

Parikh, Samir; Almaani, Salem; Brodsky, Sergey V.; Rovin, Brad H.

doi:10.1053/j.ajkd.2019.10.017

Cited by 296 publications

(325 citation statements)

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“…MMF has been shown not to be inferior to CYC for induction therapy of LN and even seems to be the preferable agent in African and Hispanic patients. Multi-target therapy has been recently proposed for induction therapy in LN [22]. In one study, the combination of tacrolimus with MMF and prednisolone (PDN) was superior to CYC and PDN when renal response was analyzed at 6 months, but not at 18 months [23].…”

Section: Conventional Immunosuppressive Agentsmentioning

confidence: 99%

Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New

et al. 2020

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Despite recent improvements in the treatment of systemic lupus erythematosus (SLE), disease activity, comorbidities and drug toxicity significantly contribute to the risk of progressive irreversible damage accrual and increased mortality in patients with this chronic disease. Moreover, even lupus patients in remission often report residual symptoms, such as fatigue, which have a considerable impact on their health-related quality of life. In recent decades, SLE treatment has moved from the use of hydroxychloroquine, systemic glucocorticosteroids and conventional immunosuppressive drugs to biologic agents, of which belimumab is the first and only biologic agent approved for the treatment for SLE to date. Novel therapies targeting interferons, cytokines and their receptors, intracellular signals, plasma cells, T lymphocytes and co-stimulatory molecules are being evaluated. In the context of a holistic approach, growing evidence is emerging of the importance of correct lifestyle habits in the management of lupus manifestations and comorbidities. The aim of this paper is to provide an overview of current pharmacological and non-pharmacological treatment options and emerging therapies in SLE.

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Section: Conventional Immunosuppressive Agentsmentioning

confidence: 99%

Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New

et al. 2020

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“…The clinical spectrum can range from the presence of proteinuria and hematuria to acute kidney injury (AKI) requiring renal replacement therapy [33]. Lupus nephritis (LN) is the most common cause of kidney injury in SLE (occurs in ~50%) [34]. The clinical presentation and laboratory ndings in LN may differ, ranging from "silent" LN to severe proteinuria and nephrotic syndrome, which can result in AKI.…”

Section: Discussionmentioning

confidence: 99%

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

Gracia‐Ramos¹,

Saavedra-Salinas²

2020

Preprint

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Systemic lupus erythematosus (SLE) is an autoimmune and multisystemic chronic inflammatory disease that can affect various organs, including skin, joints, kidneys, lungs and the nervous system. Infectious agents have long been implicated in the pathogenesis of SLE. The new viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown that, in genetically predisposed patients, could trigger the presentation or exacerbation of autoimmune disease. We herein report a case of a 45-year-old man who presented respiratory symptoms, bilateral pleural effusion, ascites, splenomegaly, severe thrombocytopenia and renal failure with proteinuria and hematuria. SARS-CoV-2 PCR confirmed the COVID-19 diagnosis. We diagnosed the patient with SLE based on the clinical manifestations and positive immunological markers (2019 European League Against Rheumatism/American College of Rheumatology score of 18). Glucocorticoid pulses were administered to the patient with improvement in renal function. However, thrombocytopenia was also refractory to IV immunoglobulin and rituximab, so the patient underwent splenectomy. Through a systematic search of the medical literature, we retrieved 2 cases with SLE new onset and 5 cases with previous SLE diagnosis that shown activity of disease due SARS-CoV-2 infection. We herein present a systemic review of these cases and discuss the clinical manifestations that could help to the diagnosis of this clinical condition.

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“…Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with a wide range of clinical and immunological manifestations, among which lupus nephritis (LN) is the most common cause of morbidity and mortality [1]. In fact, between 50% and 60% of adult SLE patients develop signs and symptoms of kidney disease during their disease course [2,3]. The standardized mortality rate of individuals with SLE without LN is 2.4-fold higher than that for the general population, while the rate for SLE patients with LN is much greater at 6.0-6.8-fold higher than for the general population [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Comparison of complete renal response and mortality in early- and late-onset lupus nephritis: A multicenter retrospective study of a Japanese cohort

Ichinose

Kitamura

Sato

et al. 2020

Preprint

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Background: Most patients with systemic lupus erythematosus (SLE) progress to lupus nephritis (LN) within 5 years of their SLE diagnosis, although it is not uncommon for LN to develop at later time points. Here we evaluated the clinical features of early- and late-onset LN.Patients and Methods: We retrospectively analyzed the cases of 184 of the 201 patients who underwent a renal biopsy at Nagasaki University Hospital and associated community hospitals between 1990 and 2016 and were diagnosed as having LN. Early-onset was defined as the development of LN within the first 5 years after the patient's SLE diagnosis, and late-onset was defined as LN development >5 years post-diagnosis. We analyzed the complete renal response (CR) at 6 and 12 months after induction therapy, the classification of renal pathology, and the mortality of the early- and late-onset LN groups.Results: The mean follow-up duration after renal biopsy was 123±85 months. There were 113 (61.4%) early-onset patients and 71 (38.6%) late-onset patients. A multivariate analysis revealed that the following factors were predictive of CR. At 6 months: female sex (odds ratio [OR] 4.64, 95% confidence interval [CI] 1.66–12.98, p=0.002), proteinuria (OR 0.82, 95%CI 0.70–0.95, p=0.003), index of activity (0–24) (OR 0.85, 95%CI 0.74–0.97, p=0.014), and early-onset LN (OR 2.26, 95%CI 1.11–4.58, p=0.023). At 12 months: female sex (OR 3.95, 95% CI 1.62–9.64, p=0.002), index of activity (0–24) (OR 0.80, 95%CI 0.71–0.91, p<0.001), and early-onset LN (OR 1.98, 95%CI 1.04–3.79, p=0.038). In a Cox proportional hazards model, the early-onset LN group had a significantly better mortality rate than the late-onset LN group (p=0.038).Conclusions: In our cohort, early-onset LN was a better predictor of CR at 6 and 12 months. Our results suggest that early-onset LN patients had lower mortality than late-onset LN patients.

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Update on Lupus Nephritis: Core Curriculum 2020

Cited by 296 publications

References 0 publications

Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New

Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

Comparison of complete renal response and mortality in early- and late-onset lupus nephritis: A multicenter retrospective study of a Japanese cohort

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