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

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.

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

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