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Том 14 №4 2012 год - Нефрология и диализ

Совместные рекомендации Европейской лиги по борьбе с ревматизмом и Европейской почечной ассоциации – Европейской ассоциации диализа и трансплантации по ведению волчаночного нефрита у взрослых и детей (Русскоязычная версия)


Захарова Е.В.

Аннотация: Цели: Разработать рекомендации по ведению волчаночного нефрита (ВН) у взрослых и детей. Методы: Посредством поиска в PubMed произведен систематический обзор доказательной базы. Для составления вопросов, установления мнений экспертов и достижения консенсуса использовался модифицированный Дельфийский метод. Результаты: Иммуносупрессивная терапия должна проводиться на основании данных биопсии почки. Целью терапии является достижение полной ремиссии (протеинурии <0,5 г/сут с нормальной или близкой к нормальной почечной функцией). Назначение гидроксихлорохина рекомендуется всем пациентам с ВН. С учетом наиболее благоприятного соотношения эффективности и токсичность, в качестве инициальной терапии пациентам с изменениями III–IV или (±V) классов ВН (по классификации 2003 г. Международного Общества Нефрологов/Общества Почечных Морфологов), мы рекомендуем применение препаратов микофеноловой кислоты (МФК) или низких доз циклофосфамида (ЦФ) в сочетании с глюкокортикоидами. У пациентов с неблагоприятными клиническими или морфологическими проявлениями заболевания циклофосфамид может назначаться в бóльших дозах, тогда как азатиоприн является альтернативным препаратом для более легких случаев. Для лечения ВН с изменениями «чистого» V класса и нефротической протеинурией мы рекомендуем МФК в комбинации с глюкокортикоидами. При достижении положительной динамики на фоне инициальной терапии, последующую иммуносупрессию препаратами МФК или азатиоприном рекомендуется проводить в течение, по меньшей мере, 3 лет. Если для инициальной терапии применялись препараты МФК, поддерживающая терапия также должна проводиться с использованием МФК. При отсутствии эффекта от применения МФК или ЦФ, мы рекомендуем перейти с МФК на ЦФ и наоборот, или использовать ритуксимаб. При планировании беременности пациентки должны быть переведены на разрешенные для беременных препараты без уменьшения объема терапии. Лечение ВН у детей и у взрослых не различается. Выводы: Рекомендации по ведению ВН были разработаны на основании изучения доказательной базы с последующим достижением консенсуса экспертов. Русскоязычная версия рекомендаций подготовлена по инициативе РДО c разрешения целевой рабочей группы EULAR по СКВ, осуществлена от имени и по поручению рабочей группы EULAR/ERA-EDTA и одобрена рабочей группой EULAR/ERA-EDTA* Воспроизведение русскоязычной версии возможно только с разрешения рабочей группы EULAR/ERA-EDTA и руководства РДО Оригинальная версия опубликована в Ann Rheum Dis 2012; 71: 1771–1782. * Состав рабочей группы: George Bertsias, Maria Tektonidou, Zahir Amoura, Martin Aringer, Ingeborg Bajema, Jo Berden, John Boletis, Ricard Cervera, Thomas Dörner, Andrea Doria, Franco Ferrario, Jürgen Floege, Frederic Houssiau, John P.A. Ioannidis, David Isenberg, Cees G.M. Kallenberg, Liz Lightstone, Stephen D. Marks, Alberto Martini, Gabriela Moroni, Irmgard Neumann, Manuel Praga, Matthias Schneider, Argyre Starra, Vladimir Tesar, Carlos Vasconcelos, Ronald van Vollenhoven, Elena Zakharova, Marion Haubitz, Caroline Gordon, David Jayne, Dimitrios T. Boumpas.

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Ключевые слова: lupus, glomerulonephritis, chronic kidney disease, pregnancy, paediatric lupus, волчанка, гломерулонефрит, хроническая болезнь почек, беременность, волчанка у детей

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