title: Overview of lupus nephritis management guidelines and perspective from Asia.
abstract: Lupus nephritis (LN) is a common and important manifestation of systemic lupus erythematosus (SLE). Evidence suggests higher rates of lupus renal involvement in Asian populations, and maybe more severe nephritis, compared with other racial or ethnic groups. The management of LN has evolved considerably over the past three decades, based on observations from clinical studies that investigated different immunosuppressive agents including corticosteroids, cyclophosphamide, azathioprine, mycophenolic acid, calcineurin inhibitors and novel biologic therapies. This is accompanied by improvements in both the short-term treatment response rate and long-term renal function preservation. Treatment guidelines for LN have recently been issued by rheumatology and nephrology communities in U.S.A. and Europe. In view of the racial difference in disease manifestation and response to therapy, and the substantial disease burden in Asia, a panel of 15 nephrologists and rheumatologists from different Asian regions with extensive experience in lupus nephritis - the Steering Group for the Asian Lupus Nephritis Network (ALNN) - met and discussed the management of lupus nephritis in Asian patients. The group has also reviewed and deliberated on the recently published recommendations from other parts of the world. This manuscript summarizes the discussions by the group and presents consensus views on the clinical management and treatment of adult Asian patients with LN, taking into account both the available evidence and expert opinion in areas where evidence remains to be sought.
authors.affiliation: Division of Rheumatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong.
authors.forename: Chi Chiu
authors.initials: CC
authors.lastname: Mok
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.forename: Sandra V
authors.initials: SV
authors.lastname: Navarra
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Zhao
authors.forename: Liangjing
authors.initials: L
authors.lastname: Lu
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Yingyos
authors.initials: Y
authors.lastname: Avihingsanon
authors.forename: Xue-Qing
authors.initials: XQ
authors.lastname: Yu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lapid
authors.forename: Lenrore R
authors.initials: LR
authors.lastname: Lugue-Lizardo
authors.forename: Vasant
authors.initials: V
authors.lastname: Sumethkul
authors.forename: Nan
authors.initials: N
authors.lastname: Shen
authors.forename: Shun-le
authors.initials: SL
authors.lastname: Chen
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D000328:Adult; D001208:Asia / Q000453:epidemiology; D044466:Asian People; D032921:Consensus; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D009398:Nephrology / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D012219:Rheumatology / Q000592:standards*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Asia; lupus; nephritis