علاج الذئبة الحمراء في التهاب الكلية الذئبي النشط مع انخفاض الترشيح الكبيبي

References

DOI: 10.1136/ard-2023-224762

• In patients at high-risk for renal failure (defined as reduced GFR, histological presence of cellular crescents or fibrinoid necrosis, or severe interstitial inflammation), high-dose (National Institutes of Health regimen) intravenous cyclophosphamide (1a/A) in combination with pulse intravenous methylprednisolone, can be considered.
• For patients presenting with impaired kidney function or histological evidence of crescentic glomerulonephritis and/or severe interstitial inflammation, the traditional high-dose intravenous CYC regimen can also be considered, since it is the most extensively studied therapeutic regimen in severe LN, in the early studies from the NIH.
• Following renal response, treatment of lupus nephritis should continue for at least 3 years; azathioprine or mycophenolate should replace cyclophosphamide for those initially treated with cyclophosphamide alone or in combination with belimumab.
• Following the choice of initial treatment, renal response should be monitored according to the 2019 EULAR/ERA-EDTA targets (reduction in proteinuria ≥25% and 50% at 3 and 6 months, respectively, and below 500–700 mg/day at 12 months, all with GFR within 10% from baseline).