Features of the course and treatment of nephritis in systemic lupus erythematosus

Особенности течения и лечения нефрита при системной красной волчанке

Systemic lupus erythematosus − this is a disease with multi-organ damage, and in the first year of this pathology, patients have kidney damage (90%), the main mechanism of which is − deposition of immune complexes in glomeruli, tubules, basement membranes of peritubular and other capillaries of the kidneys.

Also, against the background of systemic lupus erythematosus, patients may experience nephropathy associated with antiphospholipid syndrome − thrombotic microangiopathy with damage to glomerular capillaries and renal vessels.

Read in the article on estet-portal.com what are the approaches to the diagnosis and treatment of nephritis as a consequence of systemic lupus erythematosus.

Basic approaches to the diagnosis of systemic lupus erythematosus
Goal of treatment of nephritis in systemic lupus erythematosus
Indications for immunosuppressive therapy in patients with lupus nephritist

Basic approaches to the diagnosis of systemic lupus erythematosus

American Rheumatism Association criteria for systemic lupus erythematosus

butterfly erythema;

discoid erythema;
photosensitization;
stomatitis;
arthritis;
serositis (pleurisy, pericarditis);
proteinuria> 0.5 g / day or the presence of erythrocyte casts in the urine;
increase in antinuclear antibody titers.

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immunological disorders play a big role in the diagnosis:

antibodies to double-stranded deoxyribonucleic acid (DNA);

antibodies to the Smith antigen;
antiphospholipid antibodies;
positive LE cells.

serological diagnostics

has not changed significantly in recent years, it includes the determination of antibodies to double-stranded DNA, antinuclear factor, complement levels (C3 and C4).

Diagnosis, treatment and prevention of urolithiasis from the standpoint of evidence-based medicine Determination of

antinuclear antibody titers

is a highly sensitive, but not specific method for detecting systemic lupus erythematosus: titers may be elevated for other reasons. Determination of

double-stranded DNA antibodies

is a more sensitive test, the results of which correlate with disease activity. Sometimes when anti-dsDNA levels are normal, other antibodies may be elevated.

Antiphospholipid antibodies

are present in 30% of patients and are associated with thromboembolic complicationsmi.

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Goal of treatment of nephritis in systemic lupus erythematosus

Goals of treatment for

patients with lupus nephritis include achieving induction and maintaining remissions to minimize comorbidities:

infections;

herpes zoster;
bone marrow toxicity;
chemical cystitis;
malignant diseases.

drugs for the treatment

of patients with lupus nephritis include corticosteroids, cyclophosphamide, azathioprine, mycophenolate mofetil, cyclosporine, hydroxychloroquine, immunotherapy drugs (rituximab). Reduction in proteinuria by > 50% is an important prognostic sign in patients with lupus nephritis.

The use of

cyclophosphamide

at high doses in patients with lupus nephritis does not guarantee remission, but increases the risk of side effects. Also, in a

meta-analysis

of four studies, researchers found a significant reduction in the risk of treatment failure, mortality, and end-stage renal disease in patients treated with mycophenolate mofetil compared with patients who cyclophosphamide was prescribed.

Modern features and possibilities of clinical urinalysis In another study, scientists determined that the overall rate of positive reaction (response) in patients with lupus nephritis who took

rituximab

is 91%. Rituximab can

reduce glucocorticosteroid dose

in patients, but the data are conflicting: for example, in another study, the effectiveness of rituximab in patients with lupus nephritis is only 57% compared with placebo. The use of

ACE inhibitors

in patients with lupus nephritis results in improved survival and improved renal functionk.

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Indications for immunosuppressive therapy in patients with lupus nephritis

During the first administration of

immunosuppressive treatment for

nephritis, a diagnostic kidney biopsy should be used as a guide.

Immunosuppressants

are recommended for patients with class IIIA or IIIA/C (±V) and IVA or IVA/C (±V) lupus nephritis, and "pure" nephritis. Class V if proteinuria exceeds 1 g/day despite the use of renin-angiotensin-aldosterone system blockers.

Pharmacotherapy of chronic renal failure

The ultimate goals of treatment for

patients with lupus nephritis:

long-term preservation of kidney function;