التهاب الكلى الذئبي عندما لم يُحقق العلاج المثبط للمناعة الأولي استجابة كلوية

References

DOI: 10.1016/j.ard.2025.09.007

• For patients with persistently active or relapsing disease, switching among different immunosuppressive and/or biologic drugs and referral to experts is recommended.
• Any of the alternative regimens outlined in recommendation #4 can be tried.
• In cases of monotherapy with MPAA or CYC used as initial therapy, combination therapy should now be strongly considered.
• In 2019, a recommendation for rituximab was also made in cases of nonresponding disease, based on observational evidence.
• Rituximab may still be considered if other options have failed and obinutuzumab is unavailable.
• Treatment should aim for optimisation (preservation or improvement) of kidney function within 3 months, accompanied by a reduction in proteinuria of at least 25% by 3 months, 50% by 6 months, and a UPCR target <700 mg/g by 12 months, and as low as possible afterwards.
• Together with proteinuria, stabilisation (if not improvement) of GFR to ≥80% of baseline value is desirable within the first 3 months to ensure that the patient is not deteriorating and in need of reevaluation of the treatment regimen.
• Complete renal response should be defined as UPCR <500 mg/g at any time point.