References

nid

Нефрология и диализ

Nephrology and Dialysis

1680-44222618-9801

Российское диализное общество

nid-815

Research Article

ОБЗОРЫ И ЛЕКЦИИ

REVIEWS AND LECTURES

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)

Joint European League Against Rheumatism & European Renal Association – European Dialysis and Transplant Association (EULAR/ERA-EDTA) Recommendations for the Management of Adult and Paediatric Lupus Nephritis Reproduction in Russian

Захарова

Е. В.

Zakharova

E. V.

helena.zakharova@gmail.com

ГУЗ «Московская городская клиническая больница имени С.П. Боткина»Russian Federation

2012

17062025

144206221

2025

Захарова Е.В.

Zakharova E.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://journal.nephro.ru/jour/article/view/815

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–IVA илиA/C (±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.

Reproduction in Russian prepared at the initiative of RDS by courtesy of the EULAR Task Force on SLE, made on behalf and approved by EULAR/ERA-EDTA Working Group*. Reproduction rights of Russian version belong to RDS and EILAR/ERA-EDTA Working Group. Publication of original version: Ann Rheum Dis 2012; 71: 1771–1782. 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. Objectives. To develop recommendations for the management of adult and paediatric lupus nephritis (LN). Methods. The available evidence was systematically reviewed using PubMed. A modified Delphi method was used to compile questions, elicit expert opinions and reach consensus. Results. Immunosuppressive treatment should be guided by renal biopsy, and aiming for complete renal response (proteinuria <0,5 g/24-hr with normal or near-normal renal function). Hydroxychloroquine is recommended for all LN patients. Because of a more favourable efficacy/toxicity ratio, as initial treatment for patients with class III–IVA or A/C (±V) LN according to the International Society of Nephrology/Renal Pathology Society 2003 classification, we recommend mycophenolic acid (MPA) or low-dose intravenous cyclophosphamide in combination with glucocorticoids. In patients with adverse clinical or histological features, cyclophosphamide can be prescribed at higher doses, while azathioprine is an alternative for milder cases. For pure class V LN with nephrotic-range proteinuria, we recommend MPA in combination with oral glucocorticoids as initial treatment. In patients improving after initial treatment, subsequent immunosuppression with MPA or azathioprine is recommended for at least 3 years; in such cases, initial treatment with MPA should be followed by MPA. For MPA or cyclophosphamide failures, we recommend switching to the other agent, or to rituximab. In anticipation of pregnancy, patients should be switched to appropriate medications without reducing the intensity of treatment. There is no evidence to suggest that management of LN should differ in children versus adults. Conclusion. Recommendations for the management of LN were developed using an evidence-based approach followed by expert consensus.

lupusglomerulonephritischronic kidney diseasepregnancypaediatric lupusволчанкагломерулонефритхроническая болезнь почекбеременностьволчанка у детей

References1

Bertsias G., Ioannidis J.P., Boletis J. et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics // Ann. Rheum. Dis. 2008. Vol. 67. P. 195–205.

Dougados M., Betteridge N., Burmester G.R. et al. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees // Ann. Rheum. Dis. 2004. Vol. 63. P. 1172–1176.

Appenzeller S., Clark A., Pineau C. et al. Isolated pyuria in systemic lupus erythematosus // Lupus. 2010. Vol. 19. P. 793–796.

Rahman P., Gladman D.D., Ibanez D. et al. Significance of isolated hematuria and isolated pyuria in systemic lupus erythematosus // Lupus. 2001. Vol. 10. P. 418–423.

Leaker B., Fairley K.F., Dowling J. et al. Lupus nephritis: clinical and pathological correlation // Q. J. Med. 1987. Vol. 62. P. 163–179.

Nossent H.C., Henzen-Logmans S.C., Vroom T.M. et al. Contribution of renal biopsy data in predicting outcome in lupus nephritis. Analysis of 116 patients // Arthritis Rheum. 1990. Vol. 33. P. 970–977.

Tisseverasinghe A., Lim S., Greenwood C. et al. Association between serum total cholesterol level and renal outcome in systemic lupus erythematosus // Arthritis Rheum. 2006. Vol. 54. P. 2211–2219.

Grootscholten C., Bajema I.M., Florquin S. et al. Treatment with cyclophosphamide delays the progression of chronic lesions more effectively than does treatment with azathioprine plus methylprednisolone in patients with proliferative lupus nephritis // Arthritis Rheum. 2007. Vol. 56. P. 924–937.

Reich H.N., Gladman D.D., Urowitz M.B. et al. Persistent proteinuria and dyslipidemia increase the risk of progressive chronic kidney disease in lupus erythematosus // Kidney Int. 2011. Vol. 79. P. 914–920.

Kasitanon N., Fine D.M., Haas M. et al. Estimating renal function in lupus nephritis: comparison of the Modification of Diet in Renal Disease and Cockcroft Gault equations // Lupus. 2007. Vol. 16. P. 887–895.

Petri M., Bockenstedt L., Colman J. et al. Serial assessment of glomerular filtration rate in lupus nephropathy // Kidney Int. 1988. Vol. 34. P. 832–839.

Esdaile J.M., Levinton C., Federgreen W. et al. The clinical and renal biopsy predictors of long-term outcome in lupus nephritis: a study of 87 patients and review of the literature // Q. J. Med. 1989. Vol. 72. P. 779–833.

Moroni G., Gallelli B., Quaglini S. et al. Withdrawal of therapy in patients with proliferative lupus nephritis: long-term follow-up // Nephrol Dial Transplant. 2006. Vol. 21. P. 1541–1548.

Faurschou M., Starklint H., Halberg P. et al. Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure // J. Rheumatol. 2006. Vol. 33. P. 1563–1569.

Weening J.J., D’Agati V.D., Schwartz M.M. et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited // J. Am. Soc. Nephrol. 2004. Vol. 15. P. 241–250.

Furness P.N., Taub N. Interobserver reproducibility and application of the ISN/RPS classification of lupus nephritis-a UK-wide study // Am. J. Surg. Pathol. 2006. Vol. 30. P. 1030–1035.

Grootscholten C., Bajema I.M., Florquin S. et al. Interobserver agreement of scoring of histopathological characteristics and classification of lupus nephritis // Nephrol. Dial. Transplant. 2008. Vol. 23. P. 223–230.

O’Dell J.R., Hays R.C., Guggenheim S.J. et al. Tubulointerstitial renal disease in systemic lupus erythematosus // Arch. Intern. Med. 1985. Vol. 145. P. 1996–1999.

Esdaile J.M., Federgreen W., Quintal H. et al. Predictors of one year outcome in lupus nephritis: the importance of renal biopsy // Q. J. Med. 1991. Vol. 81. P. 907–918.

Austin H.A., 3rd, Boumpas D.T., Vaughan E.M. et al. High-risk features of lupus nephritis: importance of race and clinical and histological factors in 166 patients // Nephrol. Dial. Transplant. 1995. Vol. 10. P. 1620–1628.

Hill G.S., Delahousse M., Nochy D. et al. A new morphologic index for the evaluation of renal biopsies in lupus nephritis // Kidney Int. 2000. Vol. 58. P. 1160–1173.

Ogawa H., Kameda H., Nagasawa H. et al. Prospective study of low-dose cyclosporine A in patients with refractory lupus nephritis // Mod. Rheumatol. 2007. Vol. 17. P. 92–97.

Descombes E., Droz D., Drouet L. et al. Renal vascular lesions in lupus nephritis // Medicine (Baltimore). 1997. Vol. 76. P. 355–368.

Corwin H.L., Schwartz M.M., Lewis E.J. The importance of sample size in the interpretation of the renal biopsy // Am. J. Nephrol. 1988. Vol. 8. P. 85–89.

Magil A.B., Ballon H.S., Chan V. et al. Diffuse proliferative lupus glomerulonephritis. Determination of prognostic significance of clinical, laboratory and pathologic factors // Medicine (Baltimore). 1984. Vol. 63. P. 210–220.

Nossent H., Berden J., Swaak T. Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis // Lupus. 2000. Vol. 9. P. 504–510.

Austin H.A., 3rd, Muenz L.R., Joyce K.M. et al. Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome // Kidney Int. 1984. Vol. 25. P. 689–695.

Whiting-O’Keefe Q., Henke J.E., Shearn M.A. et al. The information content from renal biopsy in systemic lupus erythematosus // Ann. Intern. Med. 1982. Vol. 96. P. 718–723.

Whiting-O’Keefe Q., Riccardi P.J., Henke J.E. et al. Recognition of information in renal biopsies of patients with lupus nephritis // Ann. Intern. Med. 1982. Vol. 96. P. 723–727.

Faurschou M., Dreyer L., Kamper A.L. et al. Long-term mortality and renal outcome in a cohort of 100 patients with lupus nephritis // Arthritis Care Res. (Hoboken). 2010. Vol. 62. P. 873–880.

Mok C.C., Cheung T.T., Lo W.H. Minimal mesangial lupus nephritis: a systematic review // Scand. J. Rheumatol. 2010. Vol. 39. P. 181–189.

Hiramatsu N., Kuroiwa T., Ikeuchi H. et al. Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions // Rheumatology (Oxford). 2008. Vol. 47. P. 702–707.

Houssiau F.A., Vasconcelos C., D’Cruz D. et al. Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial // Arthritis Rheum. 2004. Vol. 50. P. 3934–3940.

Illei G.G., Takada K., Parkin D. et al. Renal flares are common in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy: long-term followup of a cohort of 145 patients participating in randomized controlled studies // Arthritis Rheum. 2002. Vol. 46. P. 995–1002.

Mok C.C., Ying K.Y., Ng W.L. et al. Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide // Am. J. Med. 2006. Vol. 119. 355. e25–33.

Chen Y.E., Korbet S.M., Katz R.S. et al. Value of a complete or partial remission in severe lupus nephritis // Clin. J. Am. Soc. Nephrol. 2008. Vol. 3. P. 46–53.

Mok C.C., Ying K.Y., Tang S. et al. Predictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis // Arthritis Rheum. 2004. Vol. 50. P. 2559–2568.

Moroni G., Quaglini S., Maccario M. et al. «Nephritic flares» are predictors of bad long-term renal outcome in lupus nephritis // Kidney Int. 1996. Vol. 50. P. 2047–2053.

Moroni G., Quaglini S., Gallelli B. et al. The long-term outcome of 93 patients with proliferative lupus nephritis // Nephrol. Dial. Transplant. 2007. Vol. 22. P. 2531–2539.

Ward M.M. Hospital experience and mortality in patients with systemic lupus erythematosus: which patients benefit most from treatment at highly experienced hospitals? // J. Rheumatol. 2002. Vol. 29. P. 1198–206.

Austin H.A., 3rd, Klippel J.H., Balow J.E. et al. Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs // N. Engl. J. Med. 1986. Vol. 314. P. 614–619.

Wang H.Y., Cui T.G., Hou F.F. et al. Induction treatment of proliferative lupus nephritis with leflunomide combined with prednisone: a prospective multi-centre observational study // Lupus. 2008. Vol. 17. P. 638–644.

Illei G.G., Austin H.A., Crane M. et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis // Ann. Intern. Med. 2001. Vol. 135. P. 248–257.

Houssiau F.A., Vasconcelos C., D’Cruz D. et al. The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose and high-dose intravenous cyclophosphamide // Ann. Rheum. Dis. 2010. Vol. 69. P. 61–64.

Appel G.B., Contreras G., Dooley M.A. et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis // J. Am. Soc. Nephrol. 2009. Vol. 20. P. 1103–1112.

Chan T.M., Li F.K., Tang C.S. et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group // N. Engl. J. Med. 2000. Vol. 343. P. 1156–1162.

Chan T.M., Tse K.C., Tang C.S. et al. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis // J. Am. Soc. Nephrol. 2005. Vol. 16. P. 1076–1084.

Ginzler E.M., Dooley M.A., Aranow C. et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis // N. Engl. J. Med. 2005. Vol. 353. P. 2219–2228.

Golshayan D., Pascual M., Vogt B. Mycophenolic acid formulations in adult renal transplantation – update on efficacy and tolerability // Therapeutics and clinical risk management. 2009. Vol. 5. P. 341–351.

Sollinger H.W., Sundberg A.K., Leverson G. et al. Mycophenolate mofetil versus enteric-coated mycophenolate sodium: a large, single-center comparison of dose adjustments and outcomes in kidney transplant recipients // Transplantation. 2010. Vol. 89. P. 446–451.

Zeher M., Doria A., Lan J. et al. Efficacy and safety of enteric-coated mycophenolate sodium in combination with two glucocorticoid regimens for the treatment of active lupus nephritis // Lupus. 2011. Vol. 20. P. 1484–1493.

Houssiau F.A., Vasconcelos C., D’Cruz D. et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide // Arthritis Rheum. 2002. Vol. 46. P. 2121–2131.

Austin H.A., 3rd, Illei G.G., Braun M.J. et al. Randomized, controlled trial of prednisone, cyclophosphamide, and cyclosporine in lupus membranous nephropathy // J. Am. Soc. Nephrol. 2009. Vol. 20. P. 901–911.

Radhakrishnan J., Moutzouris D.A., Ginzler E.M. et al. Mycophenolate mofetil and intravenous cyclophosphamide are similar as induction therapy for class V lupus nephritis // Kidney Int. 2010. Vol. 77. P. 152–160.

Isenberg D., Appel G.B., Contreras G. et al. Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS study // Rheumatology (Oxford). 2010. Vol. 49. P. 128–140.

Ginzler E.M., Felson D.T., Anthony J.M. et al. Hypertension increases the risk of renal deterioration in systemic lupus erythematosus // J. Rheumatol. 1993. Vol. 20. P. 1694–1700.

Bakir A.A., Levy P.S., Dunea G. The prognosis of lupus nephritis in African-Americans: a retrospective analysis // Am. J. Kidney. Dis. 1994. Vol. 24. P. 159–171.

Boumpas D.T., Austin H.A., 3rd, Vaughn E.M. et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis // Lancet. 1992. Vol. 340. P. 741–745.

Grootscholten C., Ligtenberg G., Hagen E.C. et al. Azathioprine/methylprednisolone versus cyclophosphamide in proliferative lupus nephritis. A randomized controlled trial // Kidney Int. 2006. Vol. 70. P. 732–742.

Shelp W.D., Bloodworth J.M., Jr., Rieselbach R.E. Effect of azathioprine on renal histology and function in lupus nephritis // Arch. Intern. Med. 1971. Vol. 128. P. 566–573.

Badsha H., Kong K.O., Lian T.Y. et al. Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications // Lupus. 2002. Vol. 11. P. 508–513.

Kong K.O., Badsha H., Lian T.Y. et al. Low-dose pulse methylprednisolone is an effective therapy for severe SLE flares // Lupus. 2004. Vol. 13. P. 212–213.

Kraft S.W., Schwartz M.M., Korbet S.M. et al. Glomerular podocytopathy in patients with systemic lupus erythematosus // J. Am. Soc. Nephrol. 2005. Vol. 16. P. 175–179.

Han T.S., Schwartz M.M., Lewis E.J. Association of glomerular podocytopathy and nephrotic proteinuria in mesangial lupus nephritis // Lupus. 2006. Vol. 15. P. 71–75.

Marks S.D., Shah V., Pilkington C. et al. Renal tubular dysfunction in children with systemic lupus erythematosus // Pediatr. Nephrol. 2005. Vol. 20. P. 141–148.

ter Borg E.J., de Jong P.E., Meijer S.S. et al. Tubular dysfunction in proliferative lupus nephritis // Am. J. Nephrol. 1991. Vol. 11. P. 16–22.

Houssiau F.A., D’Cruz D., Sangle S. et al. Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial // Ann. Rheum. Dis. 2010. Vol. 69. P. 2083–2089.

Dooley M.A., Jayne D., Ginzler E.M. et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis // N. Engl. J. Med. 2011. Vol. 365. P. 1886–1895.

Moroni G., Doria A., Mosca M. et al. A randomized pilot trial comparing cyclosporine and azathioprine for maintenance therapy in diffuse lupus nephritis over four years // Clin. J. Am. Soc. Nephrol. 2006. Vol. 1. P. 925–932.

Radhakrishnan J., Kunis C.L., D’Agati V. et al. Cyclosporine treatment of lupus membranous nephropathy // Clin. Nephrol. 1994. Vol. 42. P. 147–154.

Schwartz M.M., Lan S.P., Bernstein J. et al. Irreproducibility of the activity and chronicity indices limits their utility in the management of lupus nephritis. Lupus Nephritis Collaborative Study Group // Am. J. Kidney Dis. 1993. Vol. 21. P. 374–377.

Gourley M.F., Austin H.A., 3rd, Scott D. et al. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial // Ann. Intern. Med. 1996. Vol. 125. P. 549–557.

Boumpas D.T., Austin H.A., 3rd, Vaughan E.M. et al. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy // Ann. Intern. Med. 1993. Vol. 119. P. 366–369.

Filler G., Hansen M., LeBlanc C. et al. Pharmacokinetics of mycophenolate mofetil for autoimmune disease in children // Pediatr. Nephrol. 2003. Vol. 18. P. 445–449.

Lertdumrongluk P., Somparn P., Kittanamongkolchai W. et al. Pharmacokinetics of mycophenolic acid in severe lupus nephritis // Kidney Int. 2010. Vol. 78. P. 389–395.

Zahr N., Arnaud L., Marquet P. et al. Mycophenolic acid area under the curve correlates with disease activity in lupus patients treated with mycophenolate mofetil // Arthritis Rheum. 2010. Vol. 62. P. 2047–2054.

Karim M.Y., Alba P., Cuadrado M.J. et al. Mycophenolate mofetil for systemic lupus erythematosus refractory to other immunosuppressive agents // Rheumatology (Oxford). 2002. Vol. 41. P. 876–882.

Moss K.E., Isenberg D.A. Comparison of renal disease severity and outcome in patients with primary antiphospholipid syndrome, antiphospholipid syndrome secondary to systemic lupus erythematosus (SLE) and SLE alone // Rheumatology (Oxford). 2001. Vol. 40. P. 863–867.

Diaz-Lagares C., Croca S., Sangle S. et al. Efficacy of rituximab in 164 patients with biopsy-proven lupus nephritis: pooled data from European cohorts // Autoimmun Rev. 2012. Vol. 11. P. 357–364.

Ramos-Casals M., Diaz-Lagares C., Soto-Cardenas M.J. et al. Rituximab therapy in lupus nephritis: current clinical evidence // Clin. Rev. Allergy Immunol. 2011. Vol. 40. P. 159–169.

Cortes-Hernandez J., Torres-Salido M.T., Medrano A.S. et al. Long-term outcomes – mycophenolate mofetil treatment for lupus nephritis with addition of tacrolimus for resistant cases // Nephrol. Dial. Transplant. 2010. Vol. 25. P. 3939–3948.

Lee T., Oh K.H., Joo K.W. et al. Tacrolimus is an alternative therapeutic option for the treatment of refractory lupus nephritis // Lupus. 2010. Vol. 19. P. 974–980.

Steinberg A.D., Kaltreider H.B., Staples P.J. et al. Cyclophosphamide in lupus nephritis: a controlled trial // Ann. Intern. Med. 1971. Vol. 75. P. 165–171.

Levy Y., Sherer Y., George J. et al. Intravenous immunoglobulin treatment of lupus nephritis // Semin. Arthritis. Rheum. 2000. Vol. 29. P. 321–327.

Harada T., Ozono Y., Miyazaki M. et al. Plasmapheresis in the treatment of rapidly progressive glomerulonephritis // Ther. Apher. 1997. Vol. 1. P. 366–369.

Stummvoll G.H., Aringer M., Smolen J.S. et al. IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study // Ann. Rheum. Dis. 2005. Vol. 64. P. 1015–1021.

Stummvoll G.H., Schmaldienst S., Smolen J.S. et al. Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity // Nephrol. Dial. Transplant. 2011. May 26.

Tam L.S., Li E.K., Wong C.K. et al. Safety and efficacy of leflunomide in the treatment of lupus nephritis refractory or intolerant to traditional immunosuppressive therapy: an open label trial // Ann. Rheum. Dis. 2006. Vol. 65. P. 417–418.

Petri M.A., Kiani A.N., Post W. et al. Lupus Atherosclerosis Prevention Study (LAPS) // Ann. Rheum. Dis. 2011. Vol. 70. P. 760–765.

Duran-Barragan S., McGwin G., Jr., Vila L.M. et al. Angiotensin-converting enzyme inhibitors delay the occurrence of renal involvement and are associated with a decreased risk of disease activity in patients with systemic lupus erythematosus – results from LUMINA (LIX): a multiethnic US cohort // Rheumatology (Oxford). 2008. Vol. 47. P. 1093–1096.

Kanda H., Kubo K., Tateishi S. et al. Antiproteinuric effect of ARB in lupus nephritis patients with persistent proteinuria despite immunosuppressive therapy // Lupus. 2005. Vol. 14. P. 288–292.

Tse K.C., Li F.K., Tang S. et al. Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinuria // Lupus. 2005. Vol. 14. P. 947–952.

Fessler B.J., Alarcon G.S., McGwin G., Jr. et al. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual // Arthritis Rheum. 2005. Vol. 52. P. 1473–1480.

Pons-Estel G.J., Alarcon G.S., McGwin G., Jr. et al. Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort // Arthritis Rheum. 2009. Vol. 61. P. 830–839.

Tsakonas E., Joseph L., Esdaile J.M. et al. A long-term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group // Lupus. 1998. Vol. 7. P. 80–85.

Marmor M.F., Kellner U., Lai T.Y. et al. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy // Ophthalmology. 2011. Vol. 118. P. 415–422.

van Assen S., Agmon-Levin N., Elkayam O. et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases // Ann. Rheum. Dis. 2011. Vol. 70. P. 414–422.

Heijstek M.W., Ott de Bruin L.M., Bijl M. et al. EULAR recommendations for vaccination in paediatric patients with rheumatic diseases // Ann. Rheum. Dis. 2011. Vol. 70. P. 1704–1712.

Mosca M., Tani C., Aringer M. et al. European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies // Ann. Rheum. Dis. 2010. Vol. 69. P. 1269–1274.

100

Nath R., Mant C., Luxton J. et al. High risk of human papillomavirus type 16 infections and of development of cervical squamous intraepithelial lesions in systemic lupus erythematosus patients // Arthritis Rheum. 2007. Vol. 57. P. 619–625.

101

Nyberg G., Eriksson O., Westberg N.G. Increased incidence of cervical atypia in women with systemic lupus erythematosus treated with chemotherapy // Arthritis Rheum. 1981. Vol. 24. P. 648–650.

102

Fine D.M., Ziegenbein M., Petri M. et al. A prospective study of protein excretion using short-interval timed urine collections in patients with lupus nephritis // Kidney Int. 2009. Vol. 76. P. 1284–1288.

103

Hebert L.A., Birmingham D.J., Shidham G. et al. Random spot urine protein/creatinine ratio is unreliable for estimating 24-hour proteinuria in individual systemic lupus erythematosus nephritis patients // Nephron Clin. Pract. 2009. Vol. 113. P. 177–182.

104

Leung Y.Y., Szeto C.C., Tam L.S. et al. Urine protein-to-creatinine ratio in an untimed urine collection is a reliable measure of proteinuria in lupus nephritis // Rheumatology (Oxford). 2007. Vol. 46. P. 649–652.

105

Hebert L.A., Dillon J.J., Middendorf D.F. et al. Relationship between appearance of urinary red blood cell/white blood cell casts and the onset of renal relapse in systemic lupus erythematosus // Am. J. Kidney Dis. 1995. Vol. 26. P. 432–438.

106

Moroni G., Radice A., Giammarresi G, et al. Are laboratory tests useful for monitoring the activity of lupus nephritis? A 6-year prospective study in a cohort of 228 patients with lupus nephritis // Ann. Rheum. Dis. 2009. Vol. 68. P. 234–237.

107

Birmingham D.J., Irshaid F., Nagaraja H.N. et al. The complex nature of serum C3 and C4 as biomarkers of lupus renal flare // Lupus. 2010. Vol. 19. P. 1272–1280.

108

Esdaile J.M., Abrahamowicz M., Joseph L. et al. Laboratory tests as predictors of disease exacerbations in systemic lupus erythematosus. Why some tests fail // Arthritis Rheum. 1996. Vol. 39. P. 370–378.

109

Ghirardello A., Villalta D., Morozzi G. et al. Diagnostic accuracy of currently available anti-double-stranded DNA antibody assays. An Italian multicentre study // Clin. Exp. Rheumatol. 2011. Vol. 29. P. 50–56.

110

Jaekell H.P., Trabandt A., Grobe N. et al. Anti-dsDNA antibody subtypes and anti-C1q antibodies: toward a more reliable diagnosis and monitoring of systemic lupus erythematosus and lupus nephritis // Lupus. 2006. Vol. 15. P. 335–345.

111

Grootscholten C., Dieker J.W., McGrath F.D. et al. A prospective study of anti-chromatin and anti-C1q autoantibodies in patients with proliferative lupus nephritis treated with cyclophosphamide pulses or azathioprine/methylprednisolone // Ann. Rheum. Dis. 2007. Vol. 66. P. 693–696.

112

Gutierrez-Adrianzen O.A., Koutouzov S., Mota R.M. et al. Diagnostic value of anti-nucleosome antibodies in the assessment of disease activity of systemic lupus erythematosus: a prospective study comparing anti-nucleosome with anti-dsDNA antibodies // J. Rheumatol. 2006. Vol. 33. P. 1538–1544.

113

Mok C.C., Ho L.Y., Leung H.W. et al. Performance of anti-C1q, antinucleosome, and anti-dsDNA antibodies for detecting concurrent disease activity of systemic lupus erythematosus // Transpl. Res. 2010. Vol. 156. P. 320–325.

114

van der Vlag J., Berden J.H. Lupus nephritis: role of antinucleosome autoantibodies // Seminars in nephrology. 2011. Vol. 31. P. 376–389.

115

Steinberg A.D., Decker J.L. A double-blind controlled trial comparing cyclophosphamide, azathioprine and placebo in the treatment of lupus glomerulonephritis // Arthritis Rheum. 1974. Vol. 17. P. 923–937.

116

Hill G.S., Delahousse M., Nochy D. et al. Predictive power of the second renal biopsy in lupus nephritis: significance of macrophages // Kidney Int. 2001. Vol. 59. P. 304–316.

117

Hill G.S., Delahousse M., Nochy D. et al. Outcome of relapse in lupus nephritis: roles of reversal of renal fibrosis and response of inflammation to therapy // Kidney Int. 2002. Vol. 61. P. 2176–2186.

118

Moroni G., Pasquali S., Quaglini S. et al. Clinical and prognostic value of serial renal biopsies in lupus nephritis // Am. J. Kidney. Dis. 1999. Vol. 34. P. 530–539.

119

Balow J.E., Austin H.A., 3rd, Muenz L.R. et al. Effect of treatment on the evolution of renal abnormalities in lupus nephritis // N. Engl. J. Med. 1984. Vol. 311. P. 491–495.

120

Correia P., Cameron J.S., Lian J.D. et al. Why do patients with lupus nephritis die? // Br. Med. J. (Clin. Res. Ed). 1985. Vol. 290. P. 126–131.

121

Perkins R.M., Reynolds J.C., Ahuja T.S. et al. Thrombotic microangiopathy in United States long-term dialysis patients // Nephrol. Dial. Transplant. 2006. Vol. 21. P. 191–196.

122

Siu Y.P., Leung K.T., Tong M.K. et al. Clinical outcomes of systemic lupus erythematosus patients undergoing continuous ambulatory peritoneal dialysis // Nephrol. Dial. Transplant. 2005. Vol. 20. P. 2797–2802.

123

Weng C.H., Hsu C.W., Yu C.C. et al. Peritoneal dialysis and hemodialysis in systemic lupus erythematosus patients: comparison of clinical outcomes // Kidney Blood Press Res. 2009. Vol. 32. P. 451–456.

124

Nossent H.C., Swaak T.J., Berden J.H. Systemic lupus erythematosus: analysis of disease activity in 55 patients with end-stage renal failure treated with hemodialysis or continuous ambulatory peritoneal dialysis. Dutch Working Party on SLE // Am. J. Med. 1990. Vol. 89. P. 169–174.

125

Ribeiro F.M., Leite M.A., Velarde G.C. et al. Activity of systemic lupus erythematosus in end-stage renal disease patients: study in a Brazilian cohort // Am. J. Nephrol. 2005. Vol. 25. P. 596–603.

126

Rodby R.A., Korbet S.M., Lewis E.J. Persistence of clinical and serologic activity in patients with systemic lupus erythematosus undergoing peritoneal dialysis // Am. J. Med. 1987. Vol. 83. P. 613–618.

127

Szeto C.C., Li P.K., Wong T.Y. et al. Factors associated with active systemic lupus erythematosus after endstage renal disease // J. Rheumatol. 1998. Vol. 25. P. 1520–1525.

128

Okano K., Yumura W., Nitta K. et al. Analysis of lupus activity in end-stage renal disease treated by hemodialysis // Intern. Med. 2001. Vol. 40. P. 598–602.

129

Sires R.L., Adler S.G., Louie J.S. et al. Poor prognosis in end-stage lupus nephritis due to nonautologous vascular access site associated septicemia and lupus flares // Am. J. Nephrol. 1989. Vol. 9. P. 279–284.

130

Rietveld A., Berden J.H. Renal replacement therapy in lupus nephritis // Nephrol. Dial. Transplant. 2008. Vol. 23. P. 3056–3060.

131

Bunnapradist S., Chung P., Peng A. et al. Outcomes of renal transplantation for recipients with lupus nephritis: analysis of the Organ Procurement and Transplantation Network database // Transplantation. 2006. Vol. 82. P. 612–618.

132

Chelamcharla M., Javaid B., Baird B.C. et al. The outcome of renal transplantation among systemic lupus erythematosus patients // Nephrol. Dial. Transplant. 2007. Vol. 22. P. 3623–3630.

133

el-Shahawy M.A., Aswad S., Mendez R.G. et al. Renal transplantation in systemic lupus erythematosus: a single-center experience with sixty-four cases // Am. J. Nephrol. 1995. Vol. 15. P. 123–128.

134

Goral S., Ynares C., Shappell S.B. et al. Recurrent lupus nephritis in renal transplant recipients revisited: it is not rare // Transplantation. 2003. Vol. 75. P. 651–656.

135

Signori Baracat A.L., Ribeiro-Alves M.A., Alves-Filho G. et al. Systemic lupus erythematosus after renal transplantation: is complement a good marker for graft survival? // Transplant Proc. 2008. Vol. 40. P. 746–748.

136

Contreras G., Mattiazzi A., Guerra G. et al. Recurrence of lupus nephritis after kidney transplantation // J. Am. Soc. Nephrol. 2010. Vol. 21. P. 1200–1207.

137

Stone J.H., Amend W.J., Criswell L.A. Outcome of renal transplantation in systemic lupus erythematosus // Semin. Arthritis Rheum. 1997. Vol. 27. P. 17–26.

138

Tang H., Chelamcharla M., Baird B.C. et al. Factors affecting kidney-transplant outcome in recipients with lupus nephritis // Clin. Transplant. 2008. Vol. 22. P. 263–272.

139

Naveed A., Nilubol C., Melancon J.K. et al. Preemptive kidney transplantation in systemic lupus erythematosus // Transplant. Proc. 2011. Vol. 43. P. 3713–3714.

140

Moroni G., Tantardini F., Gallelli B. et al. The long-term prognosis of renal transplantation in patients with lupus nephritis // Am. J. Kidney Dis. 2005. Vol. 45. P. 903–911.

141

Stone J.H., Amend W.J., Criswell L.A. Antiphospholipid antibody syndrome in renal transplantation: occurrence of clinical events in 96 consecutive patients with systemic lupus erythematosus // Am. J. Kidney Dis. 1999. Vol. 34. P. 1040–1047.

142

Vaidya S., Sellers R., Kimball P. et al. Frequency, potential risk and therapeutic intervention in end-stage renal disease patients with antiphospholipid antibody syndrome: a multicenter study // Transplantation. 2000. Vol. 69. P. 1348–1352.

143

Vaidya S., Wang C.C., Gugliuzza C. et al. Relative risk of post-transplant renal thrombosis in patients with antiphospholipid antibodies // Clin. Transplant. 1998. Vol. 12. P. 439–444.

144

Burgos P.I., Perkins E.L., Pons-Estel G.J. et al. Risk factors and impact of recurrent lupus nephritis in patients with systemic lupus erythematosus undergoing renal transplantation: data from a single US institution // Arthritis Rheum. 2009. Vol. 60. P. 2757–2766.

145

Norby G.E., Strom E.H., Midtvedt K. et al. Recurrent lupus nephritis after kidney transplantation: a surveillance biopsy study // Ann. Rheum. Dis. 2010. Vol. 69. P. 1484–1487.

146

Tektonidou M.G., Sotsiou F., Nakopoulou L. et al. Antiphospholipid syndrome nephropathy in patients with systemic lupus erythematosus and antiphospholipid antibodies: prevalence, clinical associations, and long-term outcome // Arthritis Rheum. 2004. Vol. 50. P. 2569–2579.

147

Galindo M., Gonzalo E., Martinez-Vidal M.P. et al. Immunohistochemical detection of intravascular platelet microthrombi in patients with lupus nephritis and anti-phospholipid antibodies // Rheumatology (Oxford). 2009. Vol. 48. P. 1003–1007.

148

Shen Y.M., Lee R., Frenkel E. et al. IgA antiphospholipid antibodies are an independent risk factor for thromboses // Lupus. 2008. Vol. 17. P. 996–1003.

149

Zheng H., Chen Y., Ao W. et al. Antiphospholipid antibody profiles in lupus nephritis with glomerular microthrombosis: a prospective study of 124 cases // Arthritis Res. Ther. 2009. Vol. 11. R 93.

150

Cheunsuchon B., Rungkaew P., Chawanasuntorapoj R. et al. Prevalence and clinicopathologic findings of antiphospholipid syndrome nephropathy in Thai systemic lupus erythematosus patients who underwent renal biopsies // Nephrology (Carlton). 2007. Vol. 12. P. 474–480.

151

Ruiz-Irastorza G., Cuadrado M.J., Ruiz-Arruza I. et al. Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies // Lupus. 2011. Vol. 20. P. 206–218.

152

A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group // N. Engl. J. Med. 1991. Vol. 324. P. 150–154.

153

Clowse M.E., Magder L., Witter F. et al. Hydroxychloroquine in lupus pregnancy // Arthritis Rheum. 2006. Vol. 54. P. 3640–3647.

154

Clowse M.E., Magder L.S., Witter F. et al. Early risk factors for pregnancy loss in lupus // Obstet. Gynecol. 2006. Vol. 107. P. 293–299.

155

Kwok L.W., Tam L.S., Zhu T. et al. Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus // Lupus. 2011. Vol. 20. P. 829–836.

156

Imbasciati E., Tincani A., Gregorini G. et al. Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome // Nephrol. Dial. Transplant. 2009. Vol. 24. P. 519–525.

157

Carmona F., Font J., Moga I. et al. Class III–IV proliferative lupus nephritis and pregnancy: a study of 42 cases // Am. J. Reprod. Immunol. 2005. Vol. 53. P. 182–188.

158

Smyth A., Oliveira G.H., Lahr B.D. et al. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis // Clin. J. Am. Soc. Nephrol. 2010. Vol. 5. P. 2060–2068.

159

Buyon J.P., Cronstein B.N., Morris M. et al. Serum complement values (C3 and C4) to differentiate between systemic lupus activity and pre-eclampsia // Am. J. Med. 1986. Vol. 81. P. 194–200.

160

Huong D.L., Wechsler B., Vauthier-Brouzes D. et al. Pregnancy in past or present lupus nephritis: a study of 32 pregnancies from a single centre // Ann. Rheum. Dis. 2001. Vol. 60. P. 599–604.

161

Chakravarty E.F., Colon I., Langen E.S. et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus // Am. J. Obstet. Gynecol. 2005. Vol. 192. P. 1897–1904.

162

Livingston B., Bonner A., Pope J. Differences in clinical manifestations between childhood-onset lupus and adult-onset lupus: a meta-analysis // Lupus. 2011. Vol. 20. P. 1345–1355.

163

Rzany B., Coresh J., Whelton P.K. et al. Risk factors for hypercreatinemia in patients with systemic lupus erythematosus // Lupus. 1999. Vol. 8. P. 532–540.

164

Ravelli A., Duarte-Salazar C., Buratti S. et al. Assessment of damage in juvenile-onset systemic lupus erythematosus: a multicenter cohort study // Arthritis Rheum. 2003. Vol. 49. P. 501–507.

165

Brunner H.I., Gladman D.D., Ibanez D. et al. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus // Arthritis Rheum. 2008. Vol. 58. P. 556–562.

166

Hiraki L.T., Benseler S.M., Tyrrell P.N. et al. Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupus erythematosus: a longitudinal study // J. Pediatr. 2008. Vol. 152. P. 550–556.

167

Hersh A.O., von Scheven E., Yazdany J. et al. Differences in long-term disease activity and treatment of adult patients with childhood- and adult-onset systemic lupus erythematosus // Arthritis Rheum. 2009. Vol. 61. P. 13–20.

168

Taddio A., Rossetto E., Rose C.D. et al. Prognostic impact of atypical presentation in pediatric systemic lupus erythematosus: results from a multicenter study // J. Pediatr. 2010. Vol. 156. P. 972–977.

169

Traynor A.E., Schroeder J., Rosa R.M. et al. Treatment of severe systemic lupus erythematosus with high-dose chemotherapy and haemopoietic stem-cell transplantation: a phase I study // Lancet. 2000. Vol. 356. P. 701–707.

170

Fu L.W., Yang L.Y., Chen W.P. et al. Clinical efficacy of cyclosporin a neoral in the treatment of paediatric lupus nephritis with heavy proteinuria // Br. J. Rheumatol. 1998. Vol. 37. P. 217–221.

171

Lau K.K., Ault B.H., Jones D.P. et al. Induction therapy for pediatric focal proliferative lupus nephritis: cyclophosphamide versus mycophenolate mofetil // J. Pediatr. Health Care. 2008. Vol. 22. P. 282–288.

172

Urowitz M.B., Ibanez D., Ali Y. et al. Outcomes in patients with active lupus nephritis requiring immunosuppressives who never received cyclophosphamide // J. Rheumatol. 2007. Vol. 34. P. 1491–1496.

The authors declare that there are no conflicts of interest present.