[Lupus-nephritis--diagnosis and treatment].
BACKGROUND
Systemic lupus erythematosus (SLE) is an autoimmune, multiorgan disease that usually affects young women. The kidneys are affected (lupus nephritis) in close to one fifth of the patients. Over the past decade earlier diagnosis and improved treatment of lupus nephritis has resulted in substantial improvement of renal function and patient survival. Despite these advances, 10 - 15 % of SLE patients with lupus nephritis progress to end-stage renal disease, requiring dialysis or renal transplantation. The article outlines main principles for diagnosing and treating lupus nephritis, according to current practice at Oslo University Hospital.


METHODS
National and international guidelines (on treatment of lupus nephritis), literature identified through a non-systematic search in PubMed and our own clinical experience form the basis for the article.


RESULTS
In lupus nephritis, low-dose cyclophosphamide and corticosteroids are topical treatment for induction therapy, and mycophenolate mofetil is an alternative treatment. We recommend maintenance treatment with azathioprine or mycophenolate mofetil for at least two years. Treatment with rituximab may be considered in patients with refractory lupus nephritis.


CONCLUSIONS
Subtypes and activity of the renal disease are decisive for choice of treatment.
Revmatologisk avdeling, Oslo universitetssykehus, Rikshospitalet, 0027 Oslo, Norway. gudrun.elisabeth.norby@rikshospitalet.no
Gudrun E
GE
Norby
Karoline
K
Lerang
Hallvard
H
Holdaas
Jan Tore
JT
Gran
Erik H
EH
Strøm
Branimir
B
Draganov
Ingrid
I
Os
Anders
A
Hartmann
Inge-Margrethe
IM
Gilboe
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D008181:Lupus Nephritis / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012008:Recurrence; D000069283:Rituximab
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D009173:Mycophenolic Acid