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Lupus nephritis: where are we now?

Abstract

PURPOSE OF REVIEW

To consider the challenges in the management of lupus nephritis with respect to diagnosis and optimal therapy for induction and maintenance of response.

RECENT FINDINGS

Despite several large clinical trials in lupus nephritis, no second line drug is licensed for use in induction of remission in lupus nephritis. An important issue is how remission and flare are defined and the role of repeat renal biopsies. On the background of negative trials with mycophenolate mofetil and rituximab, there are recent data demonstrating superiority of mycophenolate mofetil in certain subgroups. New data suggest a role for tacrolimus in the treatment of lupus nephritis. Additionally, dogma is being challenged by data showing very low and even no oral steroids can be used in mycophenolate mofetil and rituximab-based regimes.

SUMMARY

Despite the negative outcome of recent trials there is growing evidence that there are increasing opportunities in patients with lupus nephritis to offer treatments tailored to the individual needs of the patient based not only on the class and severity of their nephritis but also on their ethnicity, their desire to have children and their predictors of outcome.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Imperial College Kidney and Transplant Institute, Imperial College London, and West London Renal and Transplant Centre, Hammersmith Hospital, London, UK. l.lightstone@imperial.ac.uk

    Source

    Current opinion in rheumatology 22:3 2010 May pg 252-6

    MeSH

    Antibodies, Monoclonal
    Antibodies, Monoclonal, Murine-Derived
    Antirheumatic Agents
    Biopsy
    Drug Therapy, Combination
    Humans
    Immunologic Factors
    Kidney
    Lupus Nephritis
    Mycophenolic Acid
    Rituximab
    Steroids
    Tacrolimus

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    20305561

    Citation

    Lightstone, Liz. "Lupus Nephritis: Where Are We Now?" Current Opinion in Rheumatology, vol. 22, no. 3, 2010, pp. 252-6.
    Lightstone L. Lupus nephritis: where are we now? Curr Opin Rheumatol. 2010;22(3):252-6.
    Lightstone, L. (2010). Lupus nephritis: where are we now? Current Opinion in Rheumatology, 22(3), pp. 252-6. doi:10.1097/BOR.0b013e3283386512.
    Lightstone L. Lupus Nephritis: Where Are We Now. Curr Opin Rheumatol. 2010;22(3):252-6. PubMed PMID: 20305561.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Lupus nephritis: where are we now? A1 - Lightstone,Liz, PY - 2010/3/23/entrez PY - 2010/3/23/pubmed PY - 2010/6/16/medline SP - 252 EP - 6 JF - Current opinion in rheumatology JO - Curr Opin Rheumatol VL - 22 IS - 3 N2 - PURPOSE OF REVIEW: To consider the challenges in the management of lupus nephritis with respect to diagnosis and optimal therapy for induction and maintenance of response. RECENT FINDINGS: Despite several large clinical trials in lupus nephritis, no second line drug is licensed for use in induction of remission in lupus nephritis. An important issue is how remission and flare are defined and the role of repeat renal biopsies. On the background of negative trials with mycophenolate mofetil and rituximab, there are recent data demonstrating superiority of mycophenolate mofetil in certain subgroups. New data suggest a role for tacrolimus in the treatment of lupus nephritis. Additionally, dogma is being challenged by data showing very low and even no oral steroids can be used in mycophenolate mofetil and rituximab-based regimes. SUMMARY: Despite the negative outcome of recent trials there is growing evidence that there are increasing opportunities in patients with lupus nephritis to offer treatments tailored to the individual needs of the patient based not only on the class and severity of their nephritis but also on their ethnicity, their desire to have children and their predictors of outcome. SN - 1531-6963 UR - https://www.unboundmedicine.com/medline/citation/20305561/Lupus_nephritis:_where_are_we_now L2 - http://Insights.ovid.com/pubmed?pmid=20305561 DB - PRIME DP - Unbound Medicine ER -