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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
A. Fanouriakis, M. Kostopoulou, K. Cheema, HJ. Anders, M. Aringer, I. Bajema, J. Boletis, E. Frangou, FA. Houssiau, J. Hollis, A. Karras, F. Marchiori, SD. Marks, G. Moroni, M. Mosca, I. Parodis, M. Praga, M. Schneider, JS. Smolen, V. Tesar, M....
Jazyk angličtina Země Velká Británie
Typ dokumentu časopisecké články, směrnice pro lékařskou praxi, práce podpořená grantem
NLK
ProQuest Central
od 1939-01-01 do Před 6 měsíci
Health & Medicine (ProQuest)
od 1939-01-01 do Před 6 měsíci
Family Health Database (ProQuest)
od 1939-01-01 do Před 6 měsíci
ROAD: Directory of Open Access Scholarly Resources
- MeSH
- antirevmatika terapeutické užití MeSH
- azathioprin terapeutické užití MeSH
- chronické selhání ledvin etiologie terapie MeSH
- glukokortikoidy terapeutické užití MeSH
- hodnoty glomerulární filtrace MeSH
- hydroxychlorochin terapeutické užití MeSH
- imunosupresiva terapeutické užití MeSH
- inhibitory kalcineurinu terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- kyselina mykofenolová terapeutické užití MeSH
- lidé MeSH
- nefritida při lupus erythematodes komplikace farmakoterapie patologie patofyziologie MeSH
- proteinurie etiologie terapie MeSH
- společnosti lékařské * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Evropa MeSH
OBJECTIVE: To update the 2012 EULAR/ERA-EDTA recommendations for the management of lupus nephritis (LN). METHODS: Following 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. RESULTS: The 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. CONCLUSIONS: We have updated the EULAR recommendations for the management of LN to facilitate homogenization of patient care.
Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
Department of Medicine Cambridge University Cambridge UK
Department of Nephrology G Gennimatas General Hospital Athens Greece
Department of Nephrology Limassol General Hospital Limassol Cyprus
Department of Pathology Leiden University Medical Center Leiden The Netherlands
Division of Nephrology Department of Medicine 4 University Hospital LMU Munich Munich Germany
Division of Rheumatology Department of Medicine 3 Medical University of Vienna Vienna Austria
Lupus nurse specialist Addenbrooke's Hospital Cambridge UK
Nephrology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
Rheumatology and Immunology Center Amsterdam University Medical Center Amsterdam The Netherlands
Rheumatology Clinical Immunology and Allergy University Hospital of Heraklion Heraklion Greece
Rheumatology Unit Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
Citace poskytuje Crossref.org
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- $a Fanouriakis, Antonis $u Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, Athens, Greece. Department of Rheumatology, "Asklepieion" General Hospital, Athens, Greece.
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- $a OBJECTIVE: To update the 2012 EULAR/ERA-EDTA recommendations for the management of lupus nephritis (LN). METHODS: Following 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. RESULTS: The 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. CONCLUSIONS: We have updated the EULAR recommendations for the management of LN to facilitate homogenization of patient care.
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