title: [Consensus of the Brazilian Society of Rheumatology for the diagnosis, management and treatment of lupus nephritis].
abstract: OBJECTIVE
  To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil.
  
  
  METHODS
  Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology.
  
  
  CONCLUSIONS
  1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. 2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. 3) Risks and benefits of treatment should be shared with the patient and his/her family. 4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. 5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). 6) ACE inhibitors and/or ARBs are recommended as antiproteinuric agents for all patients (unless contraindicated). 7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including steroids and an immunosuppressive agent, even though histological confirmation is not possible. 8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient achieve and maintain a sustained and complete remission. 9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when a new renal biopsy should be considered to assist in identifying the cause of refractoriness and in the therapeutic decision.
authors.affiliation: Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. Electronic address: klumb@uol.com.br.
authors.forename: Evandro Mendes
authors.initials: EM
authors.lastname: Klumb
authors.affiliation: Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Clovis Artur Almeida
authors.initials: CA
authors.lastname: Silva
authors.affiliation: Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
authors.forename: Cristina Costa Duarte
authors.initials: CC
authors.lastname: Lanna
authors.affiliation: Disciplina de Reumatologia, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Emilia Inoue
authors.initials: EI
authors.lastname: Sato
authors.affiliation: Disciplina de Reumatologia da Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Eduardo Ferreira
authors.initials: EF
authors.lastname: Borba
authors.affiliation: Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
authors.forename: João Carlos Tavares
authors.initials: JC
authors.lastname: Brenol
authors.affiliation: Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Elisa Martins das Neves
authors.initials: EM
authors.lastname: de Albuquerque
authors.affiliation: Disciplina de Reumatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
authors.forename: Odirlei Andre
authors.initials: OA
authors.lastname: Monticielo
authors.affiliation: Disciplina de Reumatologia, Faculdade de Medicina, Universidade Estadual de Campinas, Campinas, SP, Brasil.
authors.forename: Lilian Tereza Lavras
authors.initials: LT
authors.lastname: Costallat
authors.affiliation: Serviço de Reumatologia, Hospital de Heliópolis, São Paulo, SP, Brasil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Latorre
authors.affiliation: Disciplina de Reumatologia, Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brasil.
authors.forename: Maria de Fátima Lobato da Cunha
authors.initials: Mde F
authors.lastname: Sauma
authors.affiliation: Disciplina de Reumatologia da Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Eloisa Silva Dutra de Oliveira
authors.initials: ES
authors.lastname: Bonfá
authors.affiliation: Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Francinne Machado
authors.initials: FM
authors.lastname: Ribeiro
mesh_terms: D001706:Biopsy; D001938:Brazil; D018450:Disease Progression; D006801:Humans; D008181:Lupus Nephritis / Q000175:diagnosis* / Q000628:therapy*; D012074:Remission Induction
keywords: Brasil; Brazil; Consenso; Consensus; Lupus nephritis; Lúpus eritematoso sistêmico; Nefrite lúpica; Systemic lupus erythematous; Terapêutica; Therapeutics