Liječnički vjesnik, Vol. 136 No. 7-8, 2014.
Review article
TREATMENT OF LUPUS NEPHRITIS
Srđan Novak
Abstract
Approximately 50% of patients with systemic lupus erythematosus will develop lupus nephritis. Signs of renal involvement such as proteinuria ³0.5 g/24 h especially with glomerular hematuria and/or cellular casts should be an indication for biopsy. Goals of immunosuppressive treatment in lupus nephritis is remission with avoidance of treatment-related harms. Initial treatment for patients with class III (±V) and class IV (±V) LN are intravenous cyclophosphamide (total dose 3 g over 3 months) or mycophenolate mofetil (or mycophenolic acid) in target dose of 3 g/day for 6 months, always in combination with glucocorticoids, wihile in class V, mycophenolate mofetil in combination with glucocorticoids is recommended. In patients improving after initial treatment, mycophenolate mofetil at lower doses (2 g/day) or azatioprine (2 mg/kg/day), both in combination with low dose prednisone for at least 3 years are recommended. In resistant and relapse cases switch from cyclophosphamide to mycophenolate mofetil, or vice versa, or rituximab is recommended.
Keywords
Lupus nephritis – classification, diagnosis, drug therapy; Kidney – pathology; Immunosuppressive agents – therapeutic use, administration and dosage; Cyclophosphamide – therapeutic use, administration and dosage; Mycophenolic acid – analogs and derivatives, therapeutic use, administration and dosage; Glucocorticoids – therapeutic use, administration and dosage; Antibodies, monoclonal, murine-derived – therapeutic use, administration and dosage
Hrčak ID:
172619
URI
Publication date:
27.8.2014.
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