OP0064 Joint EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis
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Auteurs : G. Bertsias ; M. Tektonidou [Grèce] ; Z. Amoura [France] ; M. Aringer [Allemagne] ; I. Bajema [Pays-Bas] ; J. Berden [Pays-Bas] ; J. Boletis [Grèce] ; R. Cervera [Espagne] ; T. Dörner [Allemagne] ; A. Doria ; F. Ferrario [Italie] ; J. Flöge [Allemagne] ; F. Houssiau [Belgique] ; J. P. Ioannidis [États-Unis] ; D. Isenberg [Royaume-Uni] ; C. G. Kallenberg [Pays-Bas] ; L. Lightstone ; S. Marks [Royaume-Uni] ; A. Martini ; G. Moroni [Italie] ; I. Neumann [Autriche] ; P. Niaudet [France] ; M. Praga [Espagne] ; M. Schneider [Allemagne] ; V. Tesar [République tchèque] ; C. Vasconcelos [Portugal] ; R. Van Vollenhoven [Suède] ; E. Zakharova [Russie] ; M. Haubitz [Allemagne] ; C. Gordon [Royaume-Uni] ; D. Jayne [Royaume-Uni] ; 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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G. Bertsias<affiliation><mods:affiliation>University of Crete, Heraklion</mods:affiliation><wicri:noCountry code="subField">Heraklion</wicri:noCountry></affiliation><affiliation><mods:affiliation>University of Padova, Padova</mods:affiliation><wicri:noCountry code="subField">Padova</wicri:noCountry></affiliation><affiliation><mods:affiliation>Imperial College London</mods:affiliation><wicri:noCountry code="no comma">Imperial College London</wicri:noCountry></affiliation><affiliation><mods:affiliation>University of Genoa, Genoa</mods:affiliation><wicri:noCountry code="subField">Genoa</wicri:noCountry></affiliation><affiliation><mods:affiliation>University of Crete, Heraklion</mods:affiliation><wicri:noCountry code="subField">Heraklion</wicri:noCountry></affiliation>Le document en format XML
<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><wicri:noCountry code="subField">Heraklion</wicri:noCountry></affiliation></author><author><name sortKey="Tektonidou, M" sort="Tektonidou, M" uniqKey="Tektonidou M" first="M." last="Tektonidou">M. Tektonidou</name><affiliation wicri:level="1"><mods:affiliation>Rheumatology, University of Athens, Athens, Greece</mods:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>Rheumatology, University of Athens, Athens</wicri:regionArea></affiliation></author><author><name sortKey="Amoura, Z" sort="Amoura, Z" uniqKey="Amoura Z" first="Z." last="Amoura">Z. Amoura</name><affiliation wicri:level="1"><mods:affiliation>Hôpital Pitié-Salpêtrière, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hôpital Pitié-Salpêtrière, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Aringer, M" sort="Aringer, M" uniqKey="Aringer M" first="M." last="Aringer">M. Aringer</name><affiliation wicri:level="1"><mods:affiliation>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Universitätsklinikum Carl Gustav Carus, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Bajema, I" sort="Bajema, I" uniqKey="Bajema I" first="I." last="Bajema">I. Bajema</name><affiliation wicri:level="3"><mods:affiliation>Leiden University Medical Center, Leiden</mods:affiliation><country>Pays-Bas</country><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName><wicri:orgArea>Leiden University Medical Center</wicri:orgArea></affiliation></author><author><name sortKey="Berden, J" sort="Berden, J" uniqKey="Berden J" first="J." last="Berden">J. Berden</name><affiliation wicri:level="1"><mods:affiliation>Ncmls, Nijmegen, Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Ncmls, Nijmegen</wicri:regionArea></affiliation></author><author><name sortKey="Boletis, J" sort="Boletis, J" uniqKey="Boletis J" first="J." last="Boletis">J. Boletis</name><affiliation wicri:level="1"><mods:affiliation>Laiko Hospital, Athens, Greece</mods:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>Laiko Hospital, Athens</wicri:regionArea></affiliation></author><author><name sortKey="Cervera, R" sort="Cervera, R" uniqKey="Cervera R" first="R." last="Cervera">R. Cervera</name><affiliation wicri:level="1"><mods:affiliation>Universitat de Barcelona, Barcelona, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Universitat de Barcelona, Barcelona</wicri:regionArea></affiliation></author><author><name sortKey="Dorner, T" sort="Dorner, T" uniqKey="Dorner T" first="T." last="Dörner">T. Dörner</name><affiliation wicri:level="1"><mods:affiliation>Charité - Universitätsmedizin Berlin, Berlin, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Charité - Universitätsmedizin Berlin, Berlin</wicri:regionArea></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><wicri:noCountry code="subField">Padova</wicri:noCountry></affiliation></author><author><name sortKey="Ferrario, F" sort="Ferrario, F" uniqKey="Ferrario F" first="F." last="Ferrario">F. Ferrario</name><affiliation wicri:level="1"><mods:affiliation>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>San Carlo Borromeo Hospital and Fondazione, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Floge, J" sort="Floge, J" uniqKey="Floge J" first="J." last="Flöge">J. Flöge</name><affiliation wicri:level="1"><mods:affiliation>University Hospital, Aachen, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital, Aachen</wicri:regionArea></affiliation></author><author><name sortKey="Houssiau, F" sort="Houssiau, F" uniqKey="Houssiau F" first="F." last="Houssiau">F. Houssiau</name><affiliation wicri:level="1"><mods:affiliation>Université catholique de Louvain, Brussels, Belgium</mods:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Université catholique de Louvain, Brussels</wicri:regionArea></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 wicri:level="1"><mods:affiliation>Stanford University School of Medicine, Stanford, United States</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stanford University School of Medicine, Stanford</wicri:regionArea></affiliation></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D." last="Isenberg">D. Isenberg</name><affiliation wicri:level="1"><mods:affiliation>University College Hospital, London, United Kingdom</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College Hospital, London</wicri:regionArea></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 wicri:level="1"><mods:affiliation>University Hospital Groningen, Groningen, Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>University Hospital Groningen, Groningen</wicri:regionArea></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><wicri:noCountry code="no comma">Imperial College London</wicri:noCountry></affiliation></author><author><name sortKey="Marks, S" sort="Marks, S" uniqKey="Marks S" first="S." last="Marks">S. Marks</name><affiliation wicri:level="1"><mods:affiliation>University College London Institute of Child Health, London, United Kingdom</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London Institute of Child Health, London</wicri:regionArea></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><wicri:noCountry code="subField">Genoa</wicri:noCountry></affiliation></author><author><name sortKey="Moroni, G" sort="Moroni, G" uniqKey="Moroni G" first="G." last="Moroni">G. Moroni</name><affiliation wicri:level="1"><mods:affiliation>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Fondazione Ospedale Maggiore Policlinco, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Neumann, I" sort="Neumann, I" uniqKey="Neumann I" first="I." last="Neumann">I. Neumann</name><affiliation wicri:level="1"><mods:affiliation>Fachärztin für Innere Medizin, Wien, Austria</mods:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Fachärztin für Innere Medizin, Wien</wicri:regionArea></affiliation></author><author><name sortKey="Niaudet, P" sort="Niaudet, P" uniqKey="Niaudet P" first="P." last="Niaudet">P. Niaudet</name><affiliation wicri:level="1"><mods:affiliation>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hopital Necker Enfants Malades Tour Lavoisier, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Praga, M" sort="Praga, M" uniqKey="Praga M" first="M." last="Praga">M. Praga</name><affiliation wicri:level="1"><mods:affiliation>Hospital 12 de Octubre, Madrid, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital 12 de Octubre, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Schneider, M" sort="Schneider, M" uniqKey="Schneider M" first="M." last="Schneider">M. Schneider</name><affiliation wicri:level="1"><mods:affiliation>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Heinrich-Heine-University Duesseldorf, Duesseldorf</wicri:regionArea></affiliation></author><author><name sortKey="Tesar, V" sort="Tesar, V" uniqKey="Tesar V" first="V." last="Tesar">V. Tesar</name><affiliation wicri:level="1"><mods:affiliation>Charles University, Praque, Czech Republic</mods:affiliation><country xml:lang="fr">République tchèque</country><wicri:regionArea>Charles University, Praque</wicri:regionArea></affiliation></author><author><name sortKey="Vasconcelos, C" sort="Vasconcelos, C" uniqKey="Vasconcelos C" first="C." last="Vasconcelos">C. Vasconcelos</name><affiliation wicri:level="1"><mods:affiliation>Centro Hospitalar do Porto, Porto, Portugal</mods:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Centro Hospitalar do Porto, Porto</wicri:regionArea></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 wicri:level="1"><mods:affiliation>Karolinska Institute, Stockholm, Sweden</mods:affiliation><country xml:lang="fr">Suède</country><wicri:regionArea>Karolinska Institute, Stockholm</wicri:regionArea></affiliation></author><author><name sortKey="Zakharova, E" sort="Zakharova, E" uniqKey="Zakharova E" first="E." last="Zakharova">E. Zakharova</name><affiliation wicri:level="1"><mods:affiliation>University of Moscow, Moscow, Russian Federation</mods:affiliation><country xml:lang="fr">Russie</country><wicri:regionArea>University of Moscow, Moscow</wicri:regionArea></affiliation></author><author><name sortKey="Haubitz, M" sort="Haubitz, M" uniqKey="Haubitz M" first="M." last="Haubitz">M. Haubitz</name><affiliation wicri:level="1"><mods:affiliation>Medizinische Hochschule, Hannover, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Hochschule, Hannover</wicri:regionArea></affiliation></author><author><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C." last="Gordon">C. Gordon</name><affiliation wicri:level="4"><mods:affiliation>University of Birmingham</mods:affiliation><country>Royaume-Uni</country><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName><orgName type="university">Université de Birmingham</orgName></affiliation></author><author><name sortKey="Jayne, D" sort="Jayne, D" uniqKey="Jayne D" first="D." last="Jayne">D. Jayne</name><affiliation wicri:level="1"><mods:affiliation>Cambridge University, London, United Kingdom</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Cambridge University, London</wicri:regionArea></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><wicri:noCountry code="subField">Heraklion</wicri:noCountry></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><idno type="wicri:Area/Istex/Curation">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><wicri:noCountry code="subField">Heraklion</wicri:noCountry></affiliation></author><author><name sortKey="Tektonidou, M" sort="Tektonidou, M" uniqKey="Tektonidou M" first="M." last="Tektonidou">M. Tektonidou</name><affiliation wicri:level="1"><mods:affiliation>Rheumatology, University of Athens, Athens, Greece</mods:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>Rheumatology, University of Athens, Athens</wicri:regionArea></affiliation></author><author><name sortKey="Amoura, Z" sort="Amoura, Z" uniqKey="Amoura Z" first="Z." last="Amoura">Z. Amoura</name><affiliation wicri:level="1"><mods:affiliation>Hôpital Pitié-Salpêtrière, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hôpital Pitié-Salpêtrière, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Aringer, M" sort="Aringer, M" uniqKey="Aringer M" first="M." last="Aringer">M. Aringer</name><affiliation wicri:level="1"><mods:affiliation>Universitätsklinikum Carl Gustav Carus, Dresden, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Universitätsklinikum Carl Gustav Carus, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Bajema, I" sort="Bajema, I" uniqKey="Bajema I" first="I." last="Bajema">I. Bajema</name><affiliation wicri:level="3"><mods:affiliation>Leiden University Medical Center, Leiden</mods:affiliation><country>Pays-Bas</country><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName><wicri:orgArea>Leiden University Medical Center</wicri:orgArea></affiliation></author><author><name sortKey="Berden, J" sort="Berden, J" uniqKey="Berden J" first="J." last="Berden">J. Berden</name><affiliation wicri:level="1"><mods:affiliation>Ncmls, Nijmegen, Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Ncmls, Nijmegen</wicri:regionArea></affiliation></author><author><name sortKey="Boletis, J" sort="Boletis, J" uniqKey="Boletis J" first="J." last="Boletis">J. Boletis</name><affiliation wicri:level="1"><mods:affiliation>Laiko Hospital, Athens, Greece</mods:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>Laiko Hospital, Athens</wicri:regionArea></affiliation></author><author><name sortKey="Cervera, R" sort="Cervera, R" uniqKey="Cervera R" first="R." last="Cervera">R. Cervera</name><affiliation wicri:level="1"><mods:affiliation>Universitat de Barcelona, Barcelona, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Universitat de Barcelona, Barcelona</wicri:regionArea></affiliation></author><author><name sortKey="Dorner, T" sort="Dorner, T" uniqKey="Dorner T" first="T." last="Dörner">T. Dörner</name><affiliation wicri:level="1"><mods:affiliation>Charité - Universitätsmedizin Berlin, Berlin, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Charité - Universitätsmedizin Berlin, Berlin</wicri:regionArea></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><wicri:noCountry code="subField">Padova</wicri:noCountry></affiliation></author><author><name sortKey="Ferrario, F" sort="Ferrario, F" uniqKey="Ferrario F" first="F." last="Ferrario">F. Ferrario</name><affiliation wicri:level="1"><mods:affiliation>San Carlo Borromeo Hospital and Fondazione, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>San Carlo Borromeo Hospital and Fondazione, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Floge, J" sort="Floge, J" uniqKey="Floge J" first="J." last="Flöge">J. Flöge</name><affiliation wicri:level="1"><mods:affiliation>University Hospital, Aachen, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital, Aachen</wicri:regionArea></affiliation></author><author><name sortKey="Houssiau, F" sort="Houssiau, F" uniqKey="Houssiau F" first="F." last="Houssiau">F. Houssiau</name><affiliation wicri:level="1"><mods:affiliation>Université catholique de Louvain, Brussels, Belgium</mods:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Université catholique de Louvain, Brussels</wicri:regionArea></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 wicri:level="1"><mods:affiliation>Stanford University School of Medicine, Stanford, United States</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stanford University School of Medicine, Stanford</wicri:regionArea></affiliation></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D." last="Isenberg">D. Isenberg</name><affiliation wicri:level="1"><mods:affiliation>University College Hospital, London, United Kingdom</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College Hospital, London</wicri:regionArea></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 wicri:level="1"><mods:affiliation>University Hospital Groningen, Groningen, Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>University Hospital Groningen, Groningen</wicri:regionArea></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><wicri:noCountry code="no comma">Imperial College London</wicri:noCountry></affiliation></author><author><name sortKey="Marks, S" sort="Marks, S" uniqKey="Marks S" first="S." last="Marks">S. Marks</name><affiliation wicri:level="1"><mods:affiliation>University College London Institute of Child Health, London, United Kingdom</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London Institute of Child Health, London</wicri:regionArea></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><wicri:noCountry code="subField">Genoa</wicri:noCountry></affiliation></author><author><name sortKey="Moroni, G" sort="Moroni, G" uniqKey="Moroni G" first="G." last="Moroni">G. Moroni</name><affiliation wicri:level="1"><mods:affiliation>Fondazione Ospedale Maggiore Policlinco, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Fondazione Ospedale Maggiore Policlinco, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Neumann, I" sort="Neumann, I" uniqKey="Neumann I" first="I." last="Neumann">I. Neumann</name><affiliation wicri:level="1"><mods:affiliation>Fachärztin für Innere Medizin, Wien, Austria</mods:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Fachärztin für Innere Medizin, Wien</wicri:regionArea></affiliation></author><author><name sortKey="Niaudet, P" sort="Niaudet, P" uniqKey="Niaudet P" first="P." last="Niaudet">P. Niaudet</name><affiliation wicri:level="1"><mods:affiliation>Hopital Necker Enfants Malades Tour Lavoisier, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hopital Necker Enfants Malades Tour Lavoisier, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Praga, M" sort="Praga, M" uniqKey="Praga M" first="M." last="Praga">M. Praga</name><affiliation wicri:level="1"><mods:affiliation>Hospital 12 de Octubre, Madrid, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital 12 de Octubre, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Schneider, M" sort="Schneider, M" uniqKey="Schneider M" first="M." last="Schneider">M. Schneider</name><affiliation wicri:level="1"><mods:affiliation>Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Heinrich-Heine-University Duesseldorf, Duesseldorf</wicri:regionArea></affiliation></author><author><name sortKey="Tesar, V" sort="Tesar, V" uniqKey="Tesar V" first="V." last="Tesar">V. Tesar</name><affiliation wicri:level="1"><mods:affiliation>Charles University, Praque, Czech Republic</mods:affiliation><country xml:lang="fr">République tchèque</country><wicri:regionArea>Charles University, Praque</wicri:regionArea></affiliation></author><author><name sortKey="Vasconcelos, C" sort="Vasconcelos, C" uniqKey="Vasconcelos C" first="C." last="Vasconcelos">C. Vasconcelos</name><affiliation wicri:level="1"><mods:affiliation>Centro Hospitalar do Porto, Porto, Portugal</mods:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Centro Hospitalar do Porto, Porto</wicri:regionArea></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 wicri:level="1"><mods:affiliation>Karolinska Institute, Stockholm, Sweden</mods:affiliation><country xml:lang="fr">Suède</country><wicri:regionArea>Karolinska Institute, Stockholm</wicri:regionArea></affiliation></author><author><name sortKey="Zakharova, E" sort="Zakharova, E" uniqKey="Zakharova E" first="E." last="Zakharova">E. Zakharova</name><affiliation wicri:level="1"><mods:affiliation>University of Moscow, Moscow, Russian Federation</mods:affiliation><country xml:lang="fr">Russie</country><wicri:regionArea>University of Moscow, Moscow</wicri:regionArea></affiliation></author><author><name sortKey="Haubitz, M" sort="Haubitz, M" uniqKey="Haubitz M" first="M." last="Haubitz">M. Haubitz</name><affiliation wicri:level="1"><mods:affiliation>Medizinische Hochschule, Hannover, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Hochschule, Hannover</wicri:regionArea></affiliation></author><author><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C." last="Gordon">C. Gordon</name><affiliation wicri:level="4"><mods:affiliation>University of Birmingham</mods:affiliation><country>Royaume-Uni</country><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName><orgName type="university">Université de Birmingham</orgName></affiliation></author><author><name sortKey="Jayne, D" sort="Jayne, D" uniqKey="Jayne D" first="D." last="Jayne">D. Jayne</name><affiliation wicri:level="1"><mods:affiliation>Cambridge University, London, United Kingdom</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Cambridge University, London</wicri:regionArea></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><wicri:noCountry code="subField">Heraklion</wicri:noCountry></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></record>Pour manipuler ce document sous Unix (Dilib)
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