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Lupus Nephritis

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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Huang Dedong, Zhu Feiyan, Shi Jie, Lai Xiaowei, Wang Shaoyang
Renal biopsy is a "gold standard" for establishing the diagnosis and assessing prognosis and monitoring therapy in lupus nephritis (LN) patients, but it is an invasive and inconvenient procedure. Evidences showed that interleukin-17(IL-17) and interleukin-23(IL-23) may be as alternative biomarkers for diagnosing LN, monitoring LN activity and predicting the response to treatment of LN. To analyze the roles of IL-17 and IL-23 in evaluation activity of LN and predicting active LN response to immunosuppressive treatment, by comparison between IL-17, IL-23 and clinical data of LN...
April 17, 2019: Immunology Letters
Hans-Joachim Anders, Falk Hiepe
No abstract text is available yet for this article.
May 7, 2019: Clinical Journal of the American Society of Nephrology: CJASN
Y M Chen, W T Hung, Y W Liao, C Y Hsu, T Y Hsieh, H H Chen, C W Hsieh, C T Lin, K L Lai, K T Tang, C W Tseng, W N Huang, Y H Chen
Lupus nephritis (LN) is the leading cause of mortality in lupus patients. This study aimed to investigate the treatment outcome and renal histological risk factors of LN in a tertiary referral center. Between 2006 and 2017, a retrospective observational study enrolled 148 biopsy-proven LN patients. After propensity score matching, 75 cases were included for further analysis. The classification and scoring of LN were assessed according to the International Society of Nephrology/Renal Pathology Society. Treatment response was evaluated by daily urine protein and urinalysis at two years after commencing induction treatment and the development of end-stage renal disease (ESRD)...
April 10, 2019: Lupus
Antonis Fanouriakis, Myrto Kostopoulou, Alessia Alunno, Martin Aringer, Ingeborg Bajema, John N Boletis, Ricard Cervera, Andrea Doria, Caroline Gordon, Marcello Govoni, Frédéric Houssiau, David Jayne, Marios Kouloumas, Annegret Kuhn, Janni L Larsen, Kirsten Lerstrøm, Gabriella Moroni, Marta Mosca, Matthias Schneider, Josef S Smolen, Elisabet Svenungsson, Vladimir Tesar, Angela Tincani, Anne Troldborg, Ronald van Vollenhoven, Jörg Wenzel, George Bertsias, Dimitrios T Boumpas
Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007-12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7...
March 29, 2019: Annals of the Rheumatic Diseases
Emd Smith, E Al-Abadi, K Armon, K Bailey, C Ciurtin, J Davidson, J Gardner-Medwin, K Haslam, D Hawley, A Leahy, V Leone, F McErlane, D Mewar, G Modgil, R Moots, C Pilkington, A Ramanan, S Rangaraj, P Riley, A Sridhar, N Wilkinson, M W Beresford, C M Hedrich
BACKGROUND: Juvenile-onset systemic lupus erythematosus (JSLE) is more severe than adult-onset disease, including more lupus nephritis (LN). Despite differences in phenotype/pathogenesis, treatment is based upon adult trials. This study aimed to compare treatment response, damage accrual, time to inactive LN and subsequent flare, in JSLE LN patients treated with mycophenolate mofetil (MMF) versus intravenous cyclophosphamide (IVCYC). METHODS: UK JSLE Cohort Study participants, ≤16 years at diagnosis, with ≥4 American College of Rheumatology criteria for SLE, with class III or IV LN, were eligible...
March 14, 2019: Lupus
Andreas Kronbichler, Biljana Brezina, Philipp Gauckler, Luis F Quintana, David R W Jayne
Refractory lupus nephritis indicates an inadequate response to lupus nephritis therapy. It implies persisting or worsening disease activity despite therapy, but the definition is complicated by the parameters of response, proteinuria and renal function, that do not discriminate clearly between activity and irreversible damage. Understanding the causes of refractory disease and developing treatment strategies is important because these patients are more likely to develop poor outcomes, especially end stage renal disease...
March 4, 2019: Autoimmunity Reviews
J Schreiber, U Eisenberger, K de Groot
Lupus nephritis (LN) is the most frequent and one of the most severe organ manifestations of systemic lupus erythematosus. The central pathogenetic mechanism is characterized by the loss of immune tolerance against autoantigens of the cell nucleus, which can lead to renal inflammation via the formation of nuclear autoantibodies. The clinical manifestations of LN encompass nephritic syndrome with the special form of rapidly progressive glomerulonephritis, nephrotic syndrome and thrombotic microangiopathy. The diagnostic procedures consist of renal function and urine analysis as well as the determination of serum autoantibody profiles and complement components...
March 6, 2019: Der Internist
Si-Jia Shao, Jin-Hua Hou, Guo-Tong Xie, Wen Sun, Dan-Dan Liang, Cai-Hong Zeng, Hui-Xian Zhu, Zhi-Hong Liu
OBJECTIVE: To assess how the longterm outcomes have changed over the past decades in Chinese patients with lupus nephritis (LN). The trends in patient manifestation at presentation, treatment pattern, and therapeutic effects were evaluated. METHODS: A cohort of biopsy-proven patients with LN (n = 1945) from January 1994 to December 2010 was analyzed. Treatment regimens, treatment response, renal relapse, and renal outcome were compared at different time periods (1994-1998, 1999-2004, and 2005-2010)...
March 1, 2019: Journal of Rheumatology
Rong Fu, Yong Xia, Meirong Li, Renxiang Mao, Chaohuan Guo, Mianjing Zhou, Hechang Tan, Meiling Liu, Shuang Wang, Niansheng Yang, Jijun Zhao
OBJECTIVE: Lupus nephritis (LN) is a major determinant of morbidity and mortality in systemic lupus erythematosus (SLE). Pim-1 regulates lymphocyte proliferation and activation. The role of Pim-1 in autoimmune disease remains unclear. Therefore, we hypothesize that Pim-1 inhibition would have therapeutic potential for LN. METHODS: We first analyzed Pim-1 expression in lupus-prone NZB/W F1 mice (n=6), in human peripheral blood mononuclear cells (PBMCs) of SLE patients (n=10), and in the glomeruli of LN patients (n=8)...
February 21, 2019: Arthritis & Rheumatology
Jessie J Tao, Linda T Hiraki, Deborah M Levy, Earl D Silverman
OBJECTIVE: Currently there are 2 different classification criteria for systemic lupus erythematosus (SLE): American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC). The aim of this study was to compare the sensitivities of ACR and SLICC criteria in childhood-onset SLE (cSLE) using a large, multiethnic cohort. METHODS: We conducted a retrospective study of 722 patients diagnosed with cSLE at The Hospital for Sick Children (SickKids)...
February 15, 2019: Journal of Rheumatology
Quentin Raimbourg, Éric Daugas
Systemic lupus erythematosus is the most characteristic of auto-immune disorders that can lead to tissue damage in many organs, including kidney. Lupus nephritis occurs in 10 to 40% of lupus patients. Its clinical hallmark is the appearance of a proteinuria as soon as a 0.5 g/g or 0.5 g/d threshold, which calls for a renal histological evaluation in order to determine the lupus nephritis severity and the need for specific therapy. More than half of renal biopsies lead to the diagnosis of active lupus nephritis-class III or class IV A according to the ISN/RPS classification-that are the most severe in regards to renal prognosis and mortality...
February 7, 2019: Néphrologie & Thérapeutique
A A Gasparin, N Pamplona Bueno de Andrade, V Hax, G Leví Tres, F V Veronese, O A Monticielo
Renal involvement is one of the main complications of systemic lupus erythematosus, causing a significant impact on patients' morbidity and mortality. Renal biopsy is still the gold standard of diagnosis, but it has many limitations. In this sense, several recent studies aim to identify biomarkers that not only predict disease activity and renal histology, but also lead to earlier treatment. In previous studies, the soluble vascular cell adhesion molecule-1 measured in urine showed a strong association with the presence of lupus nephritis, with clinical and histological activity indexes of the disease and with more severe renal lesions...
March 2019: Lupus
Shan Zhang, Yanwei Lin, Xin Ge, Guiqin Liu, Jianjian Zhang, Shuaishuai Xu, Guangyu Wu, Sheng Chen, Jianrong Xu, Shiteng Suo
BACKGROUND: Microstructural changes of lupus nephritis (LN) kidney such as inflammatory cell infiltration or fibrosis could influence water molecular movement or diffusion, which indicates that diffusion-weighted imaging (DWI) may become a valuable tool in evaluation of this disease. PURPOSE: To explore whether multiparameter diffusion-weighted imaging (mDWI) could contribute to characterize pathological patterns in LN patients. STUDY TYPE: Retrospective...
January 18, 2019: Journal of Magnetic Resonance Imaging: JMRI
Veronica G Anania, Kebing Yu, Francesco Pingitore, Qingling Li, Christopher M Rose, Peter Liu, Wendy Sandoval, Ann E Herman, Jennie R Lill, W Rodney Mathews
Lupus nephritis (LN) is a severe clinical manifestation of systemic lupus erythematosus (SLE) associated with significant morbidity and mortality. Assessment of severity and activity of renal involvement in SLE requires a kidney biopsy, an invasive procedure with limited prognostic value. Noninvasive biomarkers are needed to inform treatment decisions and to monitor disease activity. Proteinuria is associated with disease progression in LN; however, the composition of the LN urinary proteome remains incompletely characterized...
March 1, 2019: Journal of Proteome Research
Yuan An, Yunshan Zhou, Liqi Bi, Bo Liu, Hong Wang, Jin Lin, Danyi Xu, Mei Wang, Jing Zhang, Yongfu Wang, Yan An, Ping Zhu, Ronghua Xie, Zhiyi Zhang, Yifang Mei, Xiangyuan Liu, Xiaoli Deng, Zhongqiang Yao, Zhuoli Zhang, Yu Wang, Weiguo Xiao, Hui Shen, Xiuyan Yang, Hanshi Xu, Feng Yu, Guochun Wang, Xin Lu, Yang Li, Yingnan Li, Xiaoxia Zuo, Yisha Li, Yi Liu, Yi Zhao, Jianping Guo, Lingyun Sun, Minghui Zhao, Zhanguo Li
OBJECTIVES: The standard strategy for treating lupus nephritis comprises glucocorticoids together with either intravenous cyclophosphamide or oral mycophenolate mofetil, but the low remission rate is still a challenge in practice. This study was aimed to seek higher remission rate of lupus nephritis using a combined strategy. METHOD: A 24-week trial was conducted in 17 rheumatology or nephrology centers in China. A total of 191 lupus nephritis patients were randomized to follow a combined immunosuppressive treatment (CIST) with intravenous cyclophosphamide, an oral immunosuppressive agent, namely mycophenolate mofetil, azathioprine or leflunomide, and hydroxychloroquine (n = 95), or receive intravenous cyclophosphamide alone (n = 96) for 24 weeks...
April 2019: Clinical Rheumatology
Maria Infantino, Mariangela Manfredi, Paolo Soda, Mario Merone, Antonella Afeltra, Amelia Rigon
No abstract text is available yet for this article.
November 17, 2018: Annals of the Rheumatic Diseases
M Castro, M Ugolini-Lopes, E F Borba, E Bonfá, L P C Seguro
OBJECTIVE: The objective of this study is to evaluate the efficacy of a tightly controlled renoprotective protocol in systemic lupus erythematosus (SLE) patients with persistent proteinuria. METHODS: Thirteen SLE patients with nephritis and persistent proteinuria (>1 g/24 hours) were included. The protocol consisted of regular clinical evaluations every two weeks to assess blood pressure (BP, target <130/80 mmHg), adherence to therapy, diet and smoking...
December 2018: Lupus
L Pacheco-Lugo, J Sáenz-García, E Navarro Quiroz, H González Torres, L Fang, Y Díaz-Olmos, G Garavito de Egea, E Egea Bermejo, G Aroca Martínez
BACKGROUND: Systemic lupus erythematosus is a heterogeneous chronic inflammatory autoimmune disorder characterized by an exacerbated expression of cytokines and chemokines in different tissues and organs. Renal involvement is a significant contributor to the morbidity and mortality of systemic lupus erythematosus, and its diagnosis is based on renal biopsy, an invasive procedure with a high risk of complications. Therefore, the development of alternative, non-invasive diagnostic tests for kidney disease in patients with systemic lupus erythematosus is a priority...
January 2019: Lupus
Brad H Rovin, Neil Solomons, William F Pendergraft, Mary Anne Dooley, James Tumlin, Juanita Romero-Diaz, Lidia Lysenko, Sandra V Navarra, Robert B Huizinga
Calcineurin inhibitors added to standard-of-care induction therapy for lupus nephritis (LN) may increase complete renal remission (CRR) rates. The AURA-LV study tested the novel calcineurin inhibitor voclosporin for efficacy and safety in active LN. AURA-LV was a Phase 2, multicenter, randomized, double-blind, placebo-controlled trial of two doses of voclosporin (23.7 mg or 39.5 mg, each twice daily) versus placebo in combination with mycophenolate mofetil (2 g/d) and rapidly tapered low-dose oral corticosteroids for induction of remission in LN...
January 2019: Kidney International
H Hanaoka, H Iida, T Kiyokawa, Y Takakuwa, K Kawahata
We determined the clinical utility of the direct Coombs' test in the absence of hemolytic anemia as an indicator of disease activity and therapeutic response in systemic lupus erythematosus (SLE). SLE patients without hemolytic anemia who visited our hospital from January 2016 to November 2016 were retrospectively evaluated with a direct Coombs' test. Clinical features, including SLE disease activity index (SLEDAI), treatment and laboratory findings were analyzed. For patients with lupus nephritis, we additionally evaluated the cumulative complete renal response rate over one year after induction therapy...
December 2018: Lupus
2018-10-27 17:42:49
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