This article is more than 5 years old. Information may no longer be current.
SHARE project issues evidence-based recommendations for lupus nephritis
Click Here to Manage Email Alerts
The SHARE project has generated evidence-based guidance for the diagnosis and treatment of lupus nephritis, according to recently published findings.
In the SHARE project, which includes a panel of 16 pediatric rheumatologists from across Europe, performed a literature review of 9,341 articles pertaining to the diagnosis, treatment and management of childhood-onset systemic lupus erythematosus (cSLE). An evaluation of these texts for relevance yielded 55 articles for inclusion.
From this evidence, the researchers found 23 articles pertaining to lupus nephritis (LN) diagnosis and 32 were related to treatment. These articles led to six recommendations regarding diagnosis and 20 recommendations regarding treatment.
The recommendations stated that LN treatment should have the long-term objective of complete renal response, with an early morning urine protein/creatinine ratio of less than 50 mg/mmol and normal renal function. For class I, treatment could include low-dose oral corticosteroid therapy. If other organ systems are found to be involved and class 1 LN has been identified, the treatment choice should be directed by these other clinical features. For class 2 LN, low-dose oral corticosteroid treatment is a good initial treatment. This should be tapered during 3 months to 6 months. If proteinuria continues after 3 months or corticosteroid weaning is not effective, an experienced renal pathologist should reevaluate the renal biopsy to rule out misclassification. At this point, adding a disease-modifying antirheumatic drug is acceptable. In class 3/4 LN, the first-line treatment should be mycophenolate mofetil (MMF), or an intravenous cyclophosphamide/corticosteroid combination. Maintenance therapy with MMF or azathioprine may be effective for at least 3 years.
l prednisone (0.5mg/kg/day) is recommended as induction therapy for pure class 4 LN in cSLE. MMF or azathioprine are recommended as maintenance therapy.
[The] SHARE project has resulted in evidence-based recommendations for diagnosis and treatment of LN, to support uniform and high-quality care for all children with LN,” the researchers wrote. -by Jennifer Byrne
Disclosure s : The researchers report no relevant disclosures.
Click Here to Manage Email Alerts