OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis
Identifieur interne : 000F58 ( Istex/Corpus ); précédent : 000F57; suivant : 000F59OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis
Auteurs : G. Bertsias ; M. Tektonidou ; Z. Amoura ; M. Aringer ; I. Bajema ; J. Berden ; J. Boletis ; R. Cervera ; T. Dörner ; A. Doria ; F. Ferrario ; J. Flöge ; F. Houssiau ; J. P. Ioannidis ; D. Isenberg ; C. G. Kallenberg ; L. Lightstone ; S. Marks ; A. Martini ; G. Moroni ; I. Neumann ; P. Niaudet ; M. Praga ; M. Schneider ; V. Tesar ; C. Vasconcelos ; R. Van Vollenhoven ; E. Zakharova ; M. Haubitz ; C. Gordon ; D. Jayne ; D. BoumpasSource :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2013-06.
Abstract
Background There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN). Objectives To develop recommendations for the management of LN. Methods Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations. Results No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class IIIA or A/C and Class IVA or A/C (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m2) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine <2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults. Conclusions Recommendations for LN were developed using an evidence-based approach followed by expert consensus. Disclosure of Interest None Declared
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DOI: 10.1136/annrheumdis-2012-eular.1747
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</title><author><name sortKey="Bertsias, G" sort="Bertsias, G" uniqKey="Bertsias G" first="G." last="Bertsias">G. Bertsias</name><affiliation><mods:affiliation>University of Crete, Heraklion</mods:affiliation></affiliation></author><author><name sortKey="Tektonidou, M" sort="Tektonidou, M" uniqKey="Tektonidou M" first="M." last="Tektonidou">M. Tektonidou</name><affiliation><mods:affiliation>Rheumatology, University of Athens, Athens, Greece</mods:affiliation></affiliation></author><author><name sortKey="Amoura, Z" sort="Amoura, Z" uniqKey="Amoura Z" first="Z." last="Amoura">Z. Amoura</name><affiliation><mods:affiliation>Hôpital Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Aringer, M" sort="Aringer, M" uniqKey="Aringer M" first="M." last="Aringer">M. Aringer</name><affiliation><mods:affiliation>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</mods:affiliation></affiliation></author><author><name sortKey="Bajema, I" sort="Bajema, I" uniqKey="Bajema I" first="I." last="Bajema">I. Bajema</name><affiliation><mods:affiliation>Leiden University Medical Center, Leiden</mods:affiliation></affiliation></author><author><name sortKey="Berden, J" sort="Berden, J" uniqKey="Berden J" first="J." last="Berden">J. Berden</name><affiliation><mods:affiliation>Ncmls, Nijmegen, Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Boletis, J" sort="Boletis, J" uniqKey="Boletis J" first="J." last="Boletis">J. Boletis</name><affiliation><mods:affiliation>Laiko Hospital, Athens, Greece</mods:affiliation></affiliation></author><author><name sortKey="Cervera, R" sort="Cervera, R" uniqKey="Cervera R" first="R." last="Cervera">R. Cervera</name><affiliation><mods:affiliation>Universitat de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Dorner, T" sort="Dorner, T" uniqKey="Dorner T" first="T." last="Dörner">T. Dörner</name><affiliation><mods:affiliation>Charité - Universitätsmedizin Berlin, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Doria, A" sort="Doria, A" uniqKey="Doria A" first="A." last="Doria">A. Doria</name><affiliation><mods:affiliation>University of Padova, Padova</mods:affiliation></affiliation></author><author><name sortKey="Ferrario, F" sort="Ferrario, F" uniqKey="Ferrario F" first="F." last="Ferrario">F. Ferrario</name><affiliation><mods:affiliation>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Floge, J" sort="Floge, J" uniqKey="Floge J" first="J." last="Flöge">J. Flöge</name><affiliation><mods:affiliation>University Hospital, Aachen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Houssiau, F" sort="Houssiau, F" uniqKey="Houssiau F" first="F." last="Houssiau">F. Houssiau</name><affiliation><mods:affiliation>Université catholique de Louvain, Brussels, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Ioannidis, J P" sort="Ioannidis, J P" uniqKey="Ioannidis J" first="J. P." last="Ioannidis">J. P. Ioannidis</name><affiliation><mods:affiliation>Stanford University School of Medicine, Stanford, United States</mods:affiliation></affiliation></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D." last="Isenberg">D. Isenberg</name><affiliation><mods:affiliation>University College Hospital, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Kallenberg, C G" sort="Kallenberg, C G" uniqKey="Kallenberg C" first="C. G." last="Kallenberg">C. G. Kallenberg</name><affiliation><mods:affiliation>University Hospital Groningen, Groningen, Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Lightstone, L" sort="Lightstone, L" uniqKey="Lightstone L" first="L." last="Lightstone">L. Lightstone</name><affiliation><mods:affiliation>Imperial College London</mods:affiliation></affiliation></author><author><name sortKey="Marks, S" sort="Marks, S" uniqKey="Marks S" first="S." last="Marks">S. Marks</name><affiliation><mods:affiliation>University College London Institute of Child Health, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Martini, A" sort="Martini, A" uniqKey="Martini A" first="A." last="Martini">A. Martini</name><affiliation><mods:affiliation>University of Genoa, Genoa</mods:affiliation></affiliation></author><author><name sortKey="Moroni, G" sort="Moroni, G" uniqKey="Moroni G" first="G." last="Moroni">G. Moroni</name><affiliation><mods:affiliation>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Neumann, I" sort="Neumann, I" uniqKey="Neumann I" first="I." last="Neumann">I. Neumann</name><affiliation><mods:affiliation>Fachärztin für Innere Medizin, Wien, Austria</mods:affiliation></affiliation></author><author><name sortKey="Niaudet, P" sort="Niaudet, P" uniqKey="Niaudet P" first="P." last="Niaudet">P. Niaudet</name><affiliation><mods:affiliation>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Praga, M" sort="Praga, M" uniqKey="Praga M" first="M." last="Praga">M. Praga</name><affiliation><mods:affiliation>Hospital 12 de Octubre, Madrid, Spain</mods:affiliation></affiliation></author><author><name sortKey="Schneider, M" sort="Schneider, M" uniqKey="Schneider M" first="M." last="Schneider">M. Schneider</name><affiliation><mods:affiliation>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</mods:affiliation></affiliation></author><author><name sortKey="Tesar, V" sort="Tesar, V" uniqKey="Tesar V" first="V." last="Tesar">V. Tesar</name><affiliation><mods:affiliation>Charles University, Praque, Czech Republic</mods:affiliation></affiliation></author><author><name sortKey="Vasconcelos, C" sort="Vasconcelos, C" uniqKey="Vasconcelos C" first="C." last="Vasconcelos">C. Vasconcelos</name><affiliation><mods:affiliation>Centro Hospitalar do Porto, Porto, Portugal</mods:affiliation></affiliation></author><author><name sortKey="Van Vollenhoven, R" sort="Van Vollenhoven, R" uniqKey="Van Vollenhoven R" first="R." last="Van Vollenhoven">R. Van Vollenhoven</name><affiliation><mods:affiliation>Karolinska Institute, Stockholm, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Zakharova, E" sort="Zakharova, E" uniqKey="Zakharova E" first="E." last="Zakharova">E. Zakharova</name><affiliation><mods:affiliation>University of Moscow, Moscow, Russian Federation</mods:affiliation></affiliation></author><author><name sortKey="Haubitz, M" sort="Haubitz, M" uniqKey="Haubitz M" first="M." last="Haubitz">M. Haubitz</name><affiliation><mods:affiliation>Medizinische Hochschule, Hannover, Germany</mods:affiliation></affiliation></author><author><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C." last="Gordon">C. Gordon</name><affiliation><mods:affiliation>University of Birmingham</mods:affiliation></affiliation></author><author><name sortKey="Jayne, D" sort="Jayne, D" uniqKey="Jayne D" first="D." last="Jayne">D. Jayne</name><affiliation><mods:affiliation>Cambridge University, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Boumpas, D" sort="Boumpas, D" uniqKey="Boumpas D" first="D." last="Boumpas">D. Boumpas</name><affiliation><mods:affiliation>University of Crete, Heraklion</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1136/annrheumdis-2012-eular.1747</idno><idno type="url">https://api.istex.fr/document/1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000F58</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</title><author><name sortKey="Bertsias, G" sort="Bertsias, G" uniqKey="Bertsias G" first="G." last="Bertsias">G. Bertsias</name><affiliation><mods:affiliation>University of Crete, Heraklion</mods:affiliation></affiliation></author><author><name sortKey="Tektonidou, M" sort="Tektonidou, M" uniqKey="Tektonidou M" first="M." last="Tektonidou">M. Tektonidou</name><affiliation><mods:affiliation>Rheumatology, University of Athens, Athens, Greece</mods:affiliation></affiliation></author><author><name sortKey="Amoura, Z" sort="Amoura, Z" uniqKey="Amoura Z" first="Z." last="Amoura">Z. Amoura</name><affiliation><mods:affiliation>Hôpital Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Aringer, M" sort="Aringer, M" uniqKey="Aringer M" first="M." last="Aringer">M. Aringer</name><affiliation><mods:affiliation>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</mods:affiliation></affiliation></author><author><name sortKey="Bajema, I" sort="Bajema, I" uniqKey="Bajema I" first="I." last="Bajema">I. Bajema</name><affiliation><mods:affiliation>Leiden University Medical Center, Leiden</mods:affiliation></affiliation></author><author><name sortKey="Berden, J" sort="Berden, J" uniqKey="Berden J" first="J." last="Berden">J. Berden</name><affiliation><mods:affiliation>Ncmls, Nijmegen, Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Boletis, J" sort="Boletis, J" uniqKey="Boletis J" first="J." last="Boletis">J. Boletis</name><affiliation><mods:affiliation>Laiko Hospital, Athens, Greece</mods:affiliation></affiliation></author><author><name sortKey="Cervera, R" sort="Cervera, R" uniqKey="Cervera R" first="R." last="Cervera">R. Cervera</name><affiliation><mods:affiliation>Universitat de Barcelona, Barcelona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Dorner, T" sort="Dorner, T" uniqKey="Dorner T" first="T." last="Dörner">T. Dörner</name><affiliation><mods:affiliation>Charité - Universitätsmedizin Berlin, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Doria, A" sort="Doria, A" uniqKey="Doria A" first="A." last="Doria">A. Doria</name><affiliation><mods:affiliation>University of Padova, Padova</mods:affiliation></affiliation></author><author><name sortKey="Ferrario, F" sort="Ferrario, F" uniqKey="Ferrario F" first="F." last="Ferrario">F. Ferrario</name><affiliation><mods:affiliation>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Floge, J" sort="Floge, J" uniqKey="Floge J" first="J." last="Flöge">J. Flöge</name><affiliation><mods:affiliation>University Hospital, Aachen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Houssiau, F" sort="Houssiau, F" uniqKey="Houssiau F" first="F." last="Houssiau">F. Houssiau</name><affiliation><mods:affiliation>Université catholique de Louvain, Brussels, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Ioannidis, J P" sort="Ioannidis, J P" uniqKey="Ioannidis J" first="J. P." last="Ioannidis">J. P. Ioannidis</name><affiliation><mods:affiliation>Stanford University School of Medicine, Stanford, United States</mods:affiliation></affiliation></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D." last="Isenberg">D. Isenberg</name><affiliation><mods:affiliation>University College Hospital, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Kallenberg, C G" sort="Kallenberg, C G" uniqKey="Kallenberg C" first="C. G." last="Kallenberg">C. G. Kallenberg</name><affiliation><mods:affiliation>University Hospital Groningen, Groningen, Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Lightstone, L" sort="Lightstone, L" uniqKey="Lightstone L" first="L." last="Lightstone">L. Lightstone</name><affiliation><mods:affiliation>Imperial College London</mods:affiliation></affiliation></author><author><name sortKey="Marks, S" sort="Marks, S" uniqKey="Marks S" first="S." last="Marks">S. Marks</name><affiliation><mods:affiliation>University College London Institute of Child Health, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Martini, A" sort="Martini, A" uniqKey="Martini A" first="A." last="Martini">A. Martini</name><affiliation><mods:affiliation>University of Genoa, Genoa</mods:affiliation></affiliation></author><author><name sortKey="Moroni, G" sort="Moroni, G" uniqKey="Moroni G" first="G." last="Moroni">G. Moroni</name><affiliation><mods:affiliation>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Neumann, I" sort="Neumann, I" uniqKey="Neumann I" first="I." last="Neumann">I. Neumann</name><affiliation><mods:affiliation>Fachärztin für Innere Medizin, Wien, Austria</mods:affiliation></affiliation></author><author><name sortKey="Niaudet, P" sort="Niaudet, P" uniqKey="Niaudet P" first="P." last="Niaudet">P. Niaudet</name><affiliation><mods:affiliation>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Praga, M" sort="Praga, M" uniqKey="Praga M" first="M." last="Praga">M. Praga</name><affiliation><mods:affiliation>Hospital 12 de Octubre, Madrid, Spain</mods:affiliation></affiliation></author><author><name sortKey="Schneider, M" sort="Schneider, M" uniqKey="Schneider M" first="M." last="Schneider">M. Schneider</name><affiliation><mods:affiliation>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</mods:affiliation></affiliation></author><author><name sortKey="Tesar, V" sort="Tesar, V" uniqKey="Tesar V" first="V." last="Tesar">V. Tesar</name><affiliation><mods:affiliation>Charles University, Praque, Czech Republic</mods:affiliation></affiliation></author><author><name sortKey="Vasconcelos, C" sort="Vasconcelos, C" uniqKey="Vasconcelos C" first="C." last="Vasconcelos">C. Vasconcelos</name><affiliation><mods:affiliation>Centro Hospitalar do Porto, Porto, Portugal</mods:affiliation></affiliation></author><author><name sortKey="Van Vollenhoven, R" sort="Van Vollenhoven, R" uniqKey="Van Vollenhoven R" first="R." last="Van Vollenhoven">R. Van Vollenhoven</name><affiliation><mods:affiliation>Karolinska Institute, Stockholm, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Zakharova, E" sort="Zakharova, E" uniqKey="Zakharova E" first="E." last="Zakharova">E. Zakharova</name><affiliation><mods:affiliation>University of Moscow, Moscow, Russian Federation</mods:affiliation></affiliation></author><author><name sortKey="Haubitz, M" sort="Haubitz, M" uniqKey="Haubitz M" first="M." last="Haubitz">M. Haubitz</name><affiliation><mods:affiliation>Medizinische Hochschule, Hannover, Germany</mods:affiliation></affiliation></author><author><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C." last="Gordon">C. Gordon</name><affiliation><mods:affiliation>University of Birmingham</mods:affiliation></affiliation></author><author><name sortKey="Jayne, D" sort="Jayne, D" uniqKey="Jayne D" first="D." last="Jayne">D. Jayne</name><affiliation><mods:affiliation>Cambridge University, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Boumpas, D" sort="Boumpas, D" uniqKey="Boumpas D" first="D." last="Boumpas">D. Boumpas</name><affiliation><mods:affiliation>University of Crete, Heraklion</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2013-06">2013-06</date><biblScope unit="volume">71</biblScope><biblScope unit="issue">Suppl 3</biblScope><biblScope unit="page" from="74">74</biblScope></imprint><idno type="ISSN">0003-4967</idno></series><idno type="istex">1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A</idno><idno type="DOI">10.1136/annrheumdis-2012-eular.1747</idno><idno type="href">annrheumdis-71-74-3.pdf</idno><idno type="ArticleID">annrheumdis-2012-eular.1747</idno><idno type="local">annrheumdis;71/Suppl_3/74-c</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN). Objectives To develop recommendations for the management of LN. Methods Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations. Results No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class IIIA or A/C and Class IVA or A/C (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m2) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine <2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults. Conclusions Recommendations for LN were developed using an evidence-based approach followed by expert consensus. Disclosure of Interest None Declared</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>G. Bertsias</name><affiliations><json:string>University of Crete, Heraklion</json:string></affiliations></json:item><json:item><name>M. Tektonidou</name><affiliations><json:string>Rheumatology, University of Athens, Athens, Greece</json:string></affiliations></json:item><json:item><name>Z. Amoura</name><affiliations><json:string>Hôpital Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>M. Aringer</name><affiliations><json:string>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</json:string></affiliations></json:item><json:item><name>I. Bajema</name><affiliations><json:string>Leiden University Medical Center, Leiden</json:string></affiliations></json:item><json:item><name>J. Berden</name><affiliations><json:string>Ncmls, Nijmegen, Netherlands</json:string></affiliations></json:item><json:item><name>J. Boletis</name><affiliations><json:string>Laiko Hospital, Athens, Greece</json:string></affiliations></json:item><json:item><name>R. Cervera</name><affiliations><json:string>Universitat de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>T. Dörner</name><affiliations><json:string>Charité - Universitätsmedizin Berlin, Berlin, Germany</json:string></affiliations></json:item><json:item><name>A. Doria</name><affiliations><json:string>University of Padova, Padova</json:string></affiliations></json:item><json:item><name>F. Ferrario</name><affiliations><json:string>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</json:string></affiliations></json:item><json:item><name>J. Flöge</name><affiliations><json:string>University Hospital, Aachen, Germany</json:string></affiliations></json:item><json:item><name>F. Houssiau</name><affiliations><json:string>Université catholique de Louvain, Brussels, Belgium</json:string></affiliations></json:item><json:item><name>J.P. Ioannidis</name><affiliations><json:string>Stanford University School of Medicine, Stanford, United States</json:string></affiliations></json:item><json:item><name>D. Isenberg</name><affiliations><json:string>University College Hospital, London, United Kingdom</json:string></affiliations></json:item><json:item><name>C.G. Kallenberg</name><affiliations><json:string>University Hospital Groningen, Groningen, Netherlands</json:string></affiliations></json:item><json:item><name>L. Lightstone</name><affiliations><json:string>Imperial College London</json:string></affiliations></json:item><json:item><name>S. Marks</name><affiliations><json:string>University College London Institute of Child Health, London, United Kingdom</json:string></affiliations></json:item><json:item><name>A. Martini</name><affiliations><json:string>University of Genoa, Genoa</json:string></affiliations></json:item><json:item><name>G. Moroni</name><affiliations><json:string>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</json:string></affiliations></json:item><json:item><name>I. Neumann</name><affiliations><json:string>Fachärztin für Innere Medizin, Wien, Austria</json:string></affiliations></json:item><json:item><name>P. Niaudet</name><affiliations><json:string>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</json:string></affiliations></json:item><json:item><name>M. Praga</name><affiliations><json:string>Hospital 12 de Octubre, Madrid, Spain</json:string></affiliations></json:item><json:item><name>M. Schneider</name><affiliations><json:string>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</json:string></affiliations></json:item><json:item><name>V. Tesar</name><affiliations><json:string>Charles University, Praque, Czech Republic</json:string></affiliations></json:item><json:item><name>C. Vasconcelos</name><affiliations><json:string>Centro Hospitalar do Porto, Porto, Portugal</json:string></affiliations></json:item><json:item><name>R. van Vollenhoven</name><affiliations><json:string>Karolinska Institute, Stockholm, Sweden</json:string></affiliations></json:item><json:item><name>E. Zakharova</name><affiliations><json:string>University of Moscow, Moscow, Russian Federation</json:string></affiliations></json:item><json:item><name>M. Haubitz</name><affiliations><json:string>Medizinische Hochschule, Hannover, Germany</json:string></affiliations></json:item><json:item><name>C. Gordon</name><affiliations><json:string>University of Birmingham</json:string></affiliations></json:item><json:item><name>D. Jayne</name><affiliations><json:string>Cambridge University, London, United Kingdom</json:string></affiliations></json:item><json:item><name>D. Boumpas</name><affiliations><json:string>University of Crete, Heraklion</json:string></affiliations></json:item></author><articleId><json:string>annrheumdis-2012-eular.1747</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>abstract</json:string></originalGenre><abstract>Background There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN). Objectives To develop recommendations for the management of LN. Methods Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations. Results No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class IIIA or A/C and Class IVA or A/C (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m2) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine >2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults. Conclusions Recommendations for LN were developed using an evidence-based approach followed by expert consensus. Disclosure of Interest None Declared</abstract><qualityIndicators><score>6.266</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595 x 842 pts (A4)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2171</abstractCharCount><pdfWordCount>2766</pdfWordCount><pdfCharCount>17178</pdfCharCount><pdfPageCount>2</pdfPageCount><abstractWordCount>309</abstractWordCount></qualityIndicators><title>OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</title><genre><json:string>abstract</json:string></genre><host><volume>71</volume><publisherId><json:string>ard</json:string></publisherId><pages><first>74</first></pages><issn><json:string>0003-4967</json:string></issn><issue>Suppl 3</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-2060</json:string></eissn><title>Annals of the Rheumatic Diseases</title></host><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1136/annrheumdis-2012-eular.1747</json:string></doi><id>1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A</id><score>0.16973162</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><availability><p>© 2013, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</p></availability><date>2013</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</title><author xml:id="author-1"><persName><forename type="first">G.</forename><surname>Bertsias</surname></persName><affiliation>University of Crete, Heraklion</affiliation></author><author xml:id="author-2"><persName><forename type="first">M.</forename><surname>Tektonidou</surname></persName><affiliation>Rheumatology, University of Athens, Athens, Greece</affiliation></author><author xml:id="author-3"><persName><forename type="first">Z.</forename><surname>Amoura</surname></persName><affiliation>Hôpital Pitié-Salpêtrière, Paris, France</affiliation></author><author xml:id="author-4"><persName><forename type="first">M.</forename><surname>Aringer</surname></persName><affiliation>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</affiliation></author><author xml:id="author-5"><persName><forename type="first">I.</forename><surname>Bajema</surname></persName><affiliation>Leiden University Medical Center, Leiden</affiliation></author><author xml:id="author-6"><persName><forename type="first">J.</forename><surname>Berden</surname></persName><affiliation>Ncmls, Nijmegen, Netherlands</affiliation></author><author xml:id="author-7"><persName><forename type="first">J.</forename><surname>Boletis</surname></persName><affiliation>Laiko Hospital, Athens, Greece</affiliation></author><author xml:id="author-8"><persName><forename type="first">R.</forename><surname>Cervera</surname></persName><affiliation>Universitat de Barcelona, Barcelona, Spain</affiliation></author><author xml:id="author-9"><persName><forename type="first">T.</forename><surname>Dörner</surname></persName><affiliation>Charité - Universitätsmedizin Berlin, Berlin, Germany</affiliation></author><author xml:id="author-10"><persName><forename type="first">A.</forename><surname>Doria</surname></persName><affiliation>University of Padova, Padova</affiliation></author><author xml:id="author-11"><persName><forename type="first">F.</forename><surname>Ferrario</surname></persName><affiliation>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</affiliation></author><author xml:id="author-12"><persName><forename type="first">J.</forename><surname>Flöge</surname></persName><affiliation>University Hospital, Aachen, Germany</affiliation></author><author xml:id="author-13"><persName><forename type="first">F.</forename><surname>Houssiau</surname></persName><affiliation>Université catholique de Louvain, Brussels, Belgium</affiliation></author><author xml:id="author-14"><persName><forename type="first">J.P.</forename><surname>Ioannidis</surname></persName><affiliation>Stanford University School of Medicine, Stanford, United States</affiliation></author><author xml:id="author-15"><persName><forename type="first">D.</forename><surname>Isenberg</surname></persName><affiliation>University College Hospital, London, United Kingdom</affiliation></author><author xml:id="author-16"><persName><forename type="first">C.G.</forename><surname>Kallenberg</surname></persName><affiliation>University Hospital Groningen, Groningen, Netherlands</affiliation></author><author xml:id="author-17"><persName><forename type="first">L.</forename><surname>Lightstone</surname></persName><affiliation>Imperial College London</affiliation></author><author xml:id="author-18"><persName><forename type="first">S.</forename><surname>Marks</surname></persName><affiliation>University College London Institute of Child Health, London, United Kingdom</affiliation></author><author xml:id="author-19"><persName><forename type="first">A.</forename><surname>Martini</surname></persName><affiliation>University of Genoa, Genoa</affiliation></author><author xml:id="author-20"><persName><forename type="first">G.</forename><surname>Moroni</surname></persName><affiliation>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</affiliation></author><author xml:id="author-21"><persName><forename type="first">I.</forename><surname>Neumann</surname></persName><affiliation>Fachärztin für Innere Medizin, Wien, Austria</affiliation></author><author xml:id="author-22"><persName><forename type="first">P.</forename><surname>Niaudet</surname></persName><affiliation>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</affiliation></author><author xml:id="author-23"><persName><forename type="first">M.</forename><surname>Praga</surname></persName><affiliation>Hospital 12 de Octubre, Madrid, Spain</affiliation></author><author xml:id="author-24"><persName><forename type="first">M.</forename><surname>Schneider</surname></persName><affiliation>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</affiliation></author><author xml:id="author-25"><persName><forename type="first">V.</forename><surname>Tesar</surname></persName><affiliation>Charles University, Praque, Czech Republic</affiliation></author><author xml:id="author-26"><persName><forename type="first">C.</forename><surname>Vasconcelos</surname></persName><affiliation>Centro Hospitalar do Porto, Porto, Portugal</affiliation></author><author xml:id="author-27"><persName><forename type="first">R.</forename><surname>van Vollenhoven</surname></persName><affiliation>Karolinska Institute, Stockholm, Sweden</affiliation></author><author xml:id="author-28"><persName><forename type="first">E.</forename><surname>Zakharova</surname></persName><affiliation>University of Moscow, Moscow, Russian Federation</affiliation></author><author xml:id="author-29"><persName><forename type="first">M.</forename><surname>Haubitz</surname></persName><affiliation>Medizinische Hochschule, Hannover, Germany</affiliation></author><author xml:id="author-30"><persName><forename type="first">C.</forename><surname>Gordon</surname></persName><affiliation>University of Birmingham</affiliation></author><author xml:id="author-31"><persName><forename type="first">D.</forename><surname>Jayne</surname></persName><affiliation>Cambridge University, London, United Kingdom</affiliation></author><author xml:id="author-32"><persName><forename type="first">D.</forename><surname>Boumpas</surname></persName><affiliation>University of Crete, Heraklion</affiliation></author></analytic><monogr><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="pISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2013-06"></date><biblScope unit="volume">71</biblScope><biblScope unit="issue">Suppl 3</biblScope><biblScope unit="page" from="74">74</biblScope></imprint></monogr><idno type="istex">1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A</idno><idno type="DOI">10.1136/annrheumdis-2012-eular.1747</idno><idno type="href">annrheumdis-71-74-3.pdf</idno><idno type="ArticleID">annrheumdis-2012-eular.1747</idno><idno type="local">annrheumdis;71/Suppl_3/74-c</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN). Objectives To develop recommendations for the management of LN. Methods Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations. Results No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class IIIA or A/C and Class IVA or A/C (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m2) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine <2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults. Conclusions Recommendations for LN were developed using an evidence-based approach followed by expert consensus. Disclosure of Interest None Declared</p></abstract></profileDesc><revisionDesc><change when="2013-06">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-4">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="abstract" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">annrheumdis</journal-id><journal-id journal-id-type="nlm-ta">Ann Rheum Dis</journal-id><journal-id journal-id-type="publisher-id">ard</journal-id><journal-title>Annals of the Rheumatic Diseases</journal-title><abbrev-journal-title abbrev-type="publisher">Ann Rheum Dis</abbrev-journal-title><abbrev-journal-title>Ann Rheum Dis</abbrev-journal-title><issn pub-type="ppub">0003-4967</issn><issn pub-type="epub">1468-2060</issn><publisher><publisher-name>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">annrheumdis-2012-eular.1747</article-id><article-id pub-id-type="doi">10.1136/annrheumdis-2012-eular.1747</article-id><article-id pub-id-type="other">annrheumdis;71/Suppl_3/74-c</article-id><article-id pub-id-type="other">annrheumdis;annrheumdis-2012-eular.1747</article-id><article-id pub-id-type="other">74.3</article-id><article-id pub-id-type="other">annrheumdis-2012-eular.1747</article-id><article-categories><subj-group subj-group-type="heading"><subject>Scientific Abstracts</subject><subj-group><subject>Oral Presentations</subject><subj-group><subject>Abstract Session: Lupus and Sjögren’s; basics – diagnosis – treatment</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Bertsias</surname><given-names>G.</given-names></name><xref ref-type="aff" rid="AFF_1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Tektonidou</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="AFF_2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Amoura</surname><given-names>Z.</given-names></name><xref ref-type="aff" rid="AFF_3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Aringer</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="AFF_4"><sup>4</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Bajema</surname><given-names>I.</given-names></name><xref ref-type="aff" rid="AFF_5"><sup>5</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Berden</surname><given-names>J.</given-names></name><xref ref-type="aff" rid="AFF_6"><sup>6</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Boletis</surname><given-names>J.</given-names></name><xref ref-type="aff" rid="AFF_7"><sup>7</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Cervera</surname><given-names>R.</given-names></name><xref ref-type="aff" rid="AFF_8"><sup>8</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Dörner</surname><given-names>T.</given-names></name><xref ref-type="aff" rid="AFF_9"><sup>9</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Doria</surname><given-names>A.</given-names></name><xref ref-type="aff" rid="AFF_10"><sup>10</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ferrario</surname><given-names>F.</given-names></name><xref ref-type="aff" rid="AFF_11"><sup>11</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Flöge</surname><given-names>J.</given-names></name><xref ref-type="aff" rid="AFF_12"><sup>12</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Houssiau</surname><given-names>F.</given-names></name><xref ref-type="aff" rid="AFF_13"><sup>13</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ioannidis</surname><given-names>J.P.</given-names></name><xref ref-type="aff" rid="AFF_14"><sup>14</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Isenberg</surname><given-names>D.</given-names></name><xref ref-type="aff" rid="AFF_15"><sup>15</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kallenberg</surname><given-names>C.G.</given-names></name><xref ref-type="aff" rid="AFF_16"><sup>16</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lightstone</surname><given-names>L.</given-names></name><xref ref-type="aff" rid="AFF_17"><sup>17</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Marks</surname><given-names>S.</given-names></name><xref ref-type="aff" rid="AFF_18"><sup>18</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Martini</surname><given-names>A.</given-names></name><xref ref-type="aff" rid="AFF_19"><sup>19</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Moroni</surname><given-names>G.</given-names></name><xref ref-type="aff" rid="AFF_20"><sup>20</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Neumann</surname><given-names>I.</given-names></name><xref ref-type="aff" rid="AFF_21"><sup>21</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Niaudet</surname><given-names>P.</given-names></name><xref ref-type="aff" rid="AFF_22"><sup>22</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Praga</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="AFF_23"><sup>23</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Schneider</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="AFF_24"><sup>24</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Tesar</surname><given-names>V.</given-names></name><xref ref-type="aff" rid="AFF_25"><sup>25</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Vasconcelos</surname><given-names>C.</given-names></name><xref ref-type="aff" rid="AFF_26"><sup>26</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>van Vollenhoven</surname><given-names>R.</given-names></name><xref ref-type="aff" rid="AFF_27"><sup>27</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Zakharova</surname><given-names>E.</given-names></name><xref ref-type="aff" rid="AFF_28"><sup>28</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Haubitz</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="AFF_29"><sup>29</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Gordon</surname><given-names>C.</given-names></name><xref ref-type="aff" rid="AFF_30"><sup>30</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Jayne</surname><given-names>D.</given-names></name><xref ref-type="aff" rid="AFF_31"><sup>31</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Boumpas</surname><given-names>D.</given-names></name><xref ref-type="aff" rid="AFF_1"><sup>1</sup></xref></contrib></contrib-group><aff id="AFF_1"><sup>1</sup>University of Crete, Heraklion</aff><aff id="AFF_2"><sup>2</sup>Rheumatology, University of Athens, Athens, Greece</aff><aff id="AFF_3"><sup>3</sup>Hôpital Pitié-Salpêtrière, Paris, France</aff><aff id="AFF_4"><sup>4</sup>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</aff><aff id="AFF_5"><sup>5</sup>Leiden University Medical Center, Leiden</aff><aff id="AFF_6"><sup>6</sup>Ncmls, Nijmegen, Netherlands</aff><aff id="AFF_7"><sup>7</sup>Laiko Hospital, Athens, Greece</aff><aff id="AFF_8"><sup>8</sup>Universitat de Barcelona, Barcelona, Spain</aff><aff id="AFF_9"><sup>9</sup>Charité - Universitätsmedizin Berlin, Berlin, Germany</aff><aff id="AFF_10"><sup>10</sup>University of Padova, Padova</aff><aff id="AFF_11"><sup>11</sup>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</aff><aff id="AFF_12"><sup>12</sup>University Hospital, Aachen, Germany</aff><aff id="AFF_13"><sup>13</sup>Université catholique de Louvain, Brussels, Belgium</aff><aff id="AFF_14"><sup>14</sup>Stanford University School of Medicine, Stanford, United States</aff><aff id="AFF_15"><sup>15</sup>University College Hospital, London, United Kingdom</aff><aff id="AFF_16"><sup>16</sup>University Hospital Groningen, Groningen, Netherlands</aff><aff id="AFF_17"><sup>17</sup>Imperial College London</aff><aff id="AFF_18"><sup>18</sup>University College London Institute of Child Health, London, United Kingdom</aff><aff id="AFF_19"><sup>19</sup>University of Genoa, Genoa</aff><aff id="AFF_20"><sup>20</sup>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</aff><aff id="AFF_21"><sup>21</sup>Fachärztin für Innere Medizin, Wien, Austria</aff><aff id="AFF_22"><sup>22</sup>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</aff><aff id="AFF_23"><sup>23</sup>Hospital 12 de Octubre, Madrid, Spain</aff><aff id="AFF_24"><sup>24</sup>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</aff><aff id="AFF_25"><sup>25</sup>Charles University, Praque, Czech Republic</aff><aff id="AFF_26"><sup>26</sup>Centro Hospitalar do Porto, Porto, Portugal</aff><aff id="AFF_27"><sup>27</sup>Karolinska Institute, Stockholm, Sweden</aff><aff id="AFF_28"><sup>28</sup>University of Moscow, Moscow, Russian Federation</aff><aff id="AFF_29"><sup>29</sup>Medizinische Hochschule, Hannover, Germany</aff><aff id="AFF_30"><sup>30</sup>University of Birmingham</aff><aff id="AFF_31"><sup>31</sup>Cambridge University, London, United Kingdom</aff><pub-date pub-type="ppub"><month>6</month><year>2013</year></pub-date><volume>71</volume><volume-id pub-id-type="other">71</volume-id><volume-id pub-id-type="other">71</volume-id><issue>Suppl 3</issue><issue-id pub-id-type="other">annrheumdis;71/Suppl_3</issue-id><issue-id pub-id-type="other" content-type="supplement">Suppl_3</issue-id><issue-id pub-id-type="other">71/Suppl_3</issue-id><issue-title>Annual European Congress of Rheumatology EULAR abstracts 2012, 6 – 9 June 2012, Berlin, Germany</issue-title><fpage seq="3">74</fpage><permissions><copyright-statement>© 2013, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="annrheumdis-71-74-3.pdf"></self-uri><abstract><sec><title>Background</title><p>There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN).</p></sec><sec><title>Objectives</title><p>To develop recommendations for the management of LN.</p></sec><sec><title>Methods</title><p>Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations.</p></sec><sec><title>Results</title><p>No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class III<sub>A</sub> or <sub>A/C</sub> and Class IV<sub>A</sub> or <sub>A/C</sub> (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m<sup>2</sup>) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine <2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults.</p></sec><sec><title>Conclusions</title><p>Recommendations for LN were developed using an evidence-based approach followed by expert consensus.</p></sec><sec><title>Disclosure of Interest</title><p>None Declared</p></sec></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis</title></titleInfo><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Bertsias</namePart><affiliation>University of Crete, Heraklion</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Tektonidou</namePart><affiliation>Rheumatology, University of Athens, Athens, Greece</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Z.</namePart><namePart type="family">Amoura</namePart><affiliation>Hôpital Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Aringer</namePart><affiliation>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I.</namePart><namePart type="family">Bajema</namePart><affiliation>Leiden University Medical Center, Leiden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Berden</namePart><affiliation>Ncmls, Nijmegen, Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Boletis</namePart><affiliation>Laiko Hospital, Athens, Greece</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.</namePart><namePart type="family">Cervera</namePart><affiliation>Universitat de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T.</namePart><namePart type="family">Dörner</namePart><affiliation>Charité - Universitätsmedizin Berlin, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Doria</namePart><affiliation>University of Padova, Padova</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.</namePart><namePart type="family">Ferrario</namePart><affiliation>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Flöge</namePart><affiliation>University Hospital, Aachen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.</namePart><namePart type="family">Houssiau</namePart><affiliation>Université catholique de Louvain, Brussels, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.P.</namePart><namePart type="family">Ioannidis</namePart><affiliation>Stanford University School of Medicine, Stanford, United States</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Isenberg</namePart><affiliation>University College Hospital, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.G.</namePart><namePart type="family">Kallenberg</namePart><affiliation>University Hospital Groningen, Groningen, Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L.</namePart><namePart type="family">Lightstone</namePart><affiliation>Imperial College London</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.</namePart><namePart type="family">Marks</namePart><affiliation>University College London Institute of Child Health, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Martini</namePart><affiliation>University of Genoa, Genoa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Moroni</namePart><affiliation>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I.</namePart><namePart type="family">Neumann</namePart><affiliation>Fachärztin für Innere Medizin, Wien, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Niaudet</namePart><affiliation>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Praga</namePart><affiliation>Hospital 12 de Octubre, Madrid, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Schneider</namePart><affiliation>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">V.</namePart><namePart type="family">Tesar</namePart><affiliation>Charles University, Praque, Czech Republic</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Vasconcelos</namePart><affiliation>Centro Hospitalar do Porto, Porto, Portugal</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.</namePart><namePart type="family">van Vollenhoven</namePart><affiliation>Karolinska Institute, Stockholm, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E.</namePart><namePart type="family">Zakharova</namePart><affiliation>University of Moscow, Moscow, Russian Federation</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Haubitz</namePart><affiliation>Medizinische Hochschule, Hannover, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Gordon</namePart><affiliation>University of Birmingham</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Jayne</namePart><affiliation>Cambridge University, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Boumpas</namePart><affiliation>University of Crete, Heraklion</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="abstract" displayLabel="abstract"></genre><originInfo><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><dateIssued encoding="w3cdtf">2013-06</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN). Objectives To develop recommendations for the management of LN. Methods Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations. Results No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class IIIA or A/C and Class IVA or A/C (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m2) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine <2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults. Conclusions Recommendations for LN were developed using an evidence-based approach followed by expert consensus. Disclosure of Interest None Declared</abstract><relatedItem type="host"><titleInfo><title>Annals of the Rheumatic Diseases</title></titleInfo><titleInfo type="abbreviated"><title>Ann Rheum Dis</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0003-4967</identifier><identifier type="eISSN">1468-2060</identifier><identifier type="PublisherID">ard</identifier><identifier type="PublisherID-hwp">annrheumdis</identifier><identifier type="PublisherID-nlm-ta">Ann Rheum Dis</identifier><part><date>2013</date><detail type="title"><title>Annual European Congress of Rheumatology EULAR abstracts 2012, 6 – 9 June 2012, Berlin, Germany</title></detail><detail type="volume"><caption>vol.</caption><number>71</number></detail><detail type="issue"><caption>no.</caption><number>Suppl 3</number></detail><extent unit="pages"><start>74</start></extent></part></relatedItem><identifier type="istex">1A0B410ABD6F5B0BE1A18A128F48CC6A0230CF3A</identifier><identifier type="DOI">10.1136/annrheumdis-2012-eular.1747</identifier><identifier type="href">annrheumdis-71-74-3.pdf</identifier><identifier type="ArticleID">annrheumdis-2012-eular.1747</identifier><identifier type="local">annrheumdis;71/Suppl_3/74-c</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2013, Published by the BMJ Publishing Group Limited. 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