Treatment of Rapidly Progressive Glomerulonephritis in Lupus Nephritis (Diffuse Proliferative, Class IV)

Clinical Scenario

Patients with lupus nephritis — diffuse proliferative disease (class IV, and some class III cases) — who present with rapidly progressive glomerulonephritis. Initial immunosuppressive therapy combined with corticosteroids is the established approach; however, a defined subset of patients does not mount an adequate response to this standard regimen.

Treatment Approach

When the standard initial immunosuppressive regimen proves insufficient, an adjunctive plasma-based intervention — plasmapheresis — may be added to the existing therapy. The complete sequencing, selection criteria, and full regimen details are available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1007/s10157-015-1218-8

We recommend immunosuppressive agents (cyclophosphamide or mycophenolate mofetil) with corticosteroids as the initial therapy for patients with diffuse proliferative lupus nephritis.

In patients with lupus nephritis presenting with RPGN (class IV and some class III cases), the addition of immunosuppressive agents to corticosteroids in the initial therapy has been shown to improve renal function and survival.

In patients with lupus nephritis presenting with RPGN (class IV and some class III cases) in whom the standard therapy is insufficient, the addition of plasmapheresis to immunosuppressive therapy as the initial therapy may improve renal function and survival. We recommend the addition of plasmapheresis in such patients.

View source ↗