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
Url:
DOI: 10.1136/annrheumdis-2012-eular.1747
Affiliations:
- Allemagne, Autriche, Belgique, Espagne, France, Grèce, Italie, Pays-Bas, Portugal, Royaume-Uni, Russie, République tchèque, Suède, États-Unis
- Angleterre, Basse-Saxe, Berlin, Catalogne, Communauté de Madrid, District de Cologne, District de Dresde, District fédéral central, Grand Londres, Groningue (province), Gueldre, Hollande-Méridionale, Lombardie, Midlands de l'Ouest, Rhénanie-du-Nord-Westphalie, Région de Bruxelles-Capitale, Saxe (Land), Svealand, Vienne (Autriche)
- Aix-la-Chapelle, Barcelone, Berlin, Birmingham, Bruxelles, Dresde, Groningue, Hanovre, Leyde, Londres, Madrid, Milan, Moscou, Nimègue, Paris, Stockholm, Vienne (Autriche)
- Université catholique de Louvain, Université de Birmingham
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P. Ioannidis</name></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D." last="Isenberg">D. Isenberg</name></author><author><name sortKey="Kallenberg, C G" sort="Kallenberg, C G" uniqKey="Kallenberg C" first="C. G." last="Kallenberg">C. G. Kallenberg</name></author><author><name sortKey="Lightstone, L" sort="Lightstone, L" uniqKey="Lightstone L" first="L." last="Lightstone">L. Lightstone</name></author><author><name sortKey="Marks, S" sort="Marks, S" uniqKey="Marks S" first="S." last="Marks">S. Marks</name></author><author><name sortKey="Martini, A" sort="Martini, A" uniqKey="Martini A" first="A." last="Martini">A. Martini</name></author><author><name sortKey="Moroni, G" sort="Moroni, G" uniqKey="Moroni G" first="G." last="Moroni">G. Moroni</name></author><author><name sortKey="Neumann, I" sort="Neumann, I" uniqKey="Neumann I" first="I." last="Neumann">I. 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Berden</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Ncmls, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Boletis, J" sort="Boletis, J" uniqKey="Boletis J" first="J." last="Boletis">J. Boletis</name><affiliation wicri:level="1"><country xml:lang="fr">Grèce</country><wicri:regionArea>Laiko Hospital, Athens</wicri:regionArea><wicri:noRegion>Athens</wicri:noRegion></affiliation></author><author><name sortKey="Cervera, R" sort="Cervera, R" uniqKey="Cervera R" first="R." last="Cervera">R. Cervera</name><affiliation wicri:level="3"><country xml:lang="fr">Espagne</country><wicri:regionArea>Universitat de Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Dorner, T" sort="Dorner, T" uniqKey="Dorner T" first="T." last="Dörner">T. Dörner</name><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Charité - Universitätsmedizin Berlin, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Doria, A" sort="Doria, A" uniqKey="Doria A" first="A." last="Doria">A. Doria</name><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="3"><country xml:lang="fr">Italie</country><wicri:regionArea>San Carlo Borromeo Hospital and Fondazione, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Floge, J" sort="Floge, J" uniqKey="Floge J" first="J." last="Flöge">J. Flöge</name><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital, Aachen</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Cologne</region><settlement type="city">Aix-la-Chapelle</settlement></placeName></affiliation></author><author><name sortKey="Houssiau, F" sort="Houssiau, F" uniqKey="Houssiau F" first="F." last="Houssiau">F. Houssiau</name><affiliation wicri:level="4"><country xml:lang="fr">Belgique</country><wicri:regionArea>Université catholique de Louvain, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName><orgName type="university">Université catholique de Louvain</orgName></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"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stanford University School of Medicine, Stanford</wicri:regionArea><wicri:noRegion>Stanford</wicri:noRegion></affiliation></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D." last="Isenberg">D. Isenberg</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College Hospital, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></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="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>University Hospital Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Lightstone, L" sort="Lightstone, L" uniqKey="Lightstone L" first="L." last="Lightstone">L. Lightstone</name><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="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London Institute of Child Health, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Martini, A" sort="Martini, A" uniqKey="Martini A" first="A." last="Martini">A. Martini</name><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="3"><country xml:lang="fr">Italie</country><wicri:regionArea>Fondazione Ospedale Maggiore Policlinco, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Neumann, I" sort="Neumann, I" uniqKey="Neumann I" first="I." last="Neumann">I. Neumann</name><affiliation wicri:level="3"><country xml:lang="fr">Autriche</country><wicri:regionArea>Fachärztin für Innere Medizin, Wien</wicri:regionArea><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author><author><name sortKey="Niaudet, P" sort="Niaudet, P" uniqKey="Niaudet P" first="P." last="Niaudet">P. Niaudet</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Hopital Necker Enfants Malades Tour Lavoisier, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Praga, M" sort="Praga, M" uniqKey="Praga M" first="M." last="Praga">M. Praga</name><affiliation wicri:level="3"><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital 12 de Octubre, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Schneider, M" sort="Schneider, M" uniqKey="Schneider M" first="M." last="Schneider">M. Schneider</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Heinrich-Heine-University Duesseldorf, Duesseldorf</wicri:regionArea><wicri:noRegion>Duesseldorf</wicri:noRegion><wicri:noRegion>Duesseldorf</wicri:noRegion></affiliation></author><author><name sortKey="Tesar, V" sort="Tesar, V" uniqKey="Tesar V" first="V." last="Tesar">V. Tesar</name><affiliation wicri:level="1"><country xml:lang="fr">République tchèque</country><wicri:regionArea>Charles University, Praque</wicri:regionArea><wicri:noRegion>Praque</wicri:noRegion></affiliation></author><author><name sortKey="Vasconcelos, C" sort="Vasconcelos, C" uniqKey="Vasconcelos C" first="C." last="Vasconcelos">C. Vasconcelos</name><affiliation wicri:level="1"><country xml:lang="fr">Portugal</country><wicri:regionArea>Centro Hospitalar do Porto, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></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="3"><country xml:lang="fr">Suède</country><wicri:regionArea>Karolinska Institute, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="Zakharova, E" sort="Zakharova, E" uniqKey="Zakharova E" first="E." last="Zakharova">E. Zakharova</name><affiliation wicri:level="3"><country xml:lang="fr">Russie</country><wicri:regionArea>University of Moscow, Moscow</wicri:regionArea><placeName><settlement type="city">Moscou</settlement><region>District fédéral central</region></placeName></affiliation></author><author><name sortKey="Haubitz, M" sort="Haubitz, M" uniqKey="Haubitz M" first="M." last="Haubitz">M. Haubitz</name><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Hochschule, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C." last="Gordon">C. Gordon</name><affiliation wicri:level="4"><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="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Cambridge University, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Boumpas, D" sort="Boumpas, D" uniqKey="Boumpas D" first="D." last="Boumpas">D. Boumpas</name><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><affiliations><list><country><li>Allemagne</li><li>Autriche</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Grèce</li><li>Italie</li><li>Pays-Bas</li><li>Portugal</li><li>Royaume-Uni</li><li>Russie</li><li>République tchèque</li><li>Suède</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Basse-Saxe</li><li>Berlin</li><li>Catalogne</li><li>Communauté de Madrid</li><li>District de Cologne</li><li>District de Dresde</li><li>District fédéral central</li><li>Grand Londres</li><li>Groningue (province)</li><li>Gueldre</li><li>Hollande-Méridionale</li><li>Lombardie</li><li>Midlands de l'Ouest</li><li>Rhénanie-du-Nord-Westphalie</li><li>Région de Bruxelles-Capitale</li><li>Saxe (Land)</li><li>Svealand</li><li>Vienne (Autriche)</li></region><settlement><li>Aix-la-Chapelle</li><li>Barcelone</li><li>Berlin</li><li>Birmingham</li><li>Bruxelles</li><li>Dresde</li><li>Groningue</li><li>Hanovre</li><li>Leyde</li><li>Londres</li><li>Madrid</li><li>Milan</li><li>Moscou</li><li>Nimègue</li><li>Paris</li><li>Stockholm</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université catholique de Louvain</li><li>Université de Birmingham</li></orgName></list><tree><noCountry><name sortKey="Bertsias, G" sort="Bertsias, G" uniqKey="Bertsias G" first="G." last="Bertsias">G. Bertsias</name><name sortKey="Boumpas, D" sort="Boumpas, D" uniqKey="Boumpas D" first="D." last="Boumpas">D. Boumpas</name><name sortKey="Doria, A" sort="Doria, A" uniqKey="Doria A" first="A." last="Doria">A. Doria</name><name sortKey="Lightstone, L" sort="Lightstone, L" uniqKey="Lightstone L" first="L." last="Lightstone">L. Lightstone</name><name sortKey="Martini, A" sort="Martini, A" uniqKey="Martini A" first="A." last="Martini">A. Martini</name></noCountry><country name="Grèce"><noRegion><name sortKey="Tektonidou, M" sort="Tektonidou, M" uniqKey="Tektonidou M" first="M." last="Tektonidou">M. Tektonidou</name></noRegion><name sortKey="Boletis, J" sort="Boletis, J" uniqKey="Boletis J" first="J." last="Boletis">J. Boletis</name></country><country name="France"><noRegion><name sortKey="Amoura, Z" sort="Amoura, Z" uniqKey="Amoura Z" first="Z." last="Amoura">Z. Amoura</name></noRegion><name sortKey="Niaudet, P" sort="Niaudet, P" uniqKey="Niaudet P" first="P." last="Niaudet">P. Niaudet</name></country><country name="Allemagne"><region name="Saxe (Land)"><name sortKey="Aringer, M" sort="Aringer, M" uniqKey="Aringer M" first="M." last="Aringer">M. Aringer</name></region><name sortKey="Dorner, T" sort="Dorner, T" uniqKey="Dorner T" first="T." last="Dörner">T. Dörner</name><name sortKey="Floge, J" sort="Floge, J" uniqKey="Floge J" first="J." last="Flöge">J. Flöge</name><name sortKey="Haubitz, M" sort="Haubitz, M" uniqKey="Haubitz M" first="M." last="Haubitz">M. Haubitz</name><name sortKey="Schneider, M" sort="Schneider, M" uniqKey="Schneider M" first="M." last="Schneider">M. Schneider</name></country><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Bajema, I" sort="Bajema, I" uniqKey="Bajema I" first="I." last="Bajema">I. Bajema</name></region><name sortKey="Berden, J" sort="Berden, J" uniqKey="Berden J" first="J." last="Berden">J. Berden</name><name sortKey="Kallenberg, C G" sort="Kallenberg, C G" uniqKey="Kallenberg C" first="C. G." last="Kallenberg">C. G. Kallenberg</name></country><country name="Espagne"><region name="Catalogne"><name sortKey="Cervera, R" sort="Cervera, R" uniqKey="Cervera R" first="R." last="Cervera">R. Cervera</name></region><name sortKey="Praga, M" sort="Praga, M" uniqKey="Praga M" first="M." last="Praga">M. Praga</name></country><country name="Italie"><region name="Lombardie"><name sortKey="Ferrario, F" sort="Ferrario, F" uniqKey="Ferrario F" first="F." last="Ferrario">F. Ferrario</name></region><name sortKey="Moroni, G" sort="Moroni, G" uniqKey="Moroni G" first="G." last="Moroni">G. Moroni</name></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Houssiau, F" sort="Houssiau, F" uniqKey="Houssiau F" first="F." last="Houssiau">F. Houssiau</name></region></country><country name="États-Unis"><noRegion><name sortKey="Ioannidis, J P" sort="Ioannidis, J P" uniqKey="Ioannidis J" first="J. P." last="Ioannidis">J. P. Ioannidis</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D." last="Isenberg">D. Isenberg</name></region><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C." last="Gordon">C. Gordon</name><name sortKey="Jayne, D" sort="Jayne, D" uniqKey="Jayne D" first="D." last="Jayne">D. Jayne</name><name sortKey="Marks, S" sort="Marks, S" uniqKey="Marks S" first="S." last="Marks">S. Marks</name></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Neumann, I" sort="Neumann, I" uniqKey="Neumann I" first="I." last="Neumann">I. Neumann</name></region></country><country name="République tchèque"><noRegion><name sortKey="Tesar, V" sort="Tesar, V" uniqKey="Tesar V" first="V." last="Tesar">V. Tesar</name></noRegion></country><country name="Portugal"><noRegion><name sortKey="Vasconcelos, C" sort="Vasconcelos, C" uniqKey="Vasconcelos C" first="C." last="Vasconcelos">C. Vasconcelos</name></noRegion></country><country name="Suède"><region name="Svealand"><name sortKey="Van Vollenhoven, R" sort="Van Vollenhoven, R" uniqKey="Van Vollenhoven R" first="R." last="Van Vollenhoven">R. Van Vollenhoven</name></region></country><country name="Russie"><region name="District fédéral central"><name sortKey="Zakharova, E" sort="Zakharova, E" uniqKey="Zakharova E" first="E." last="Zakharova">E. Zakharova</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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