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분야
pptx2.Disease review
: Strong predictor of ESRD
- ongoing inflamations with cellular crescent, macrophages in the tubular lumens, immune deposits
Membraneous > Proliferative
Pure membranous > Superimposed Proliferative lesions( Class III + V , Class IV +V)
- 72% 10-year survival rates vs 20-48% 10-year survival rates
aggressive treatment to avoid irreversible renal damage and progression to ESRD
high-dose daily or alternate day corticosteroids
azathioprine
intravenous pulse methylprednisolone
oral or intravenous cyclophosphamide,
cyclosporine
mycophenolate mofetil
rituximab
Cyclophosphamide
reduce risk for doubling Serum Creatinine
A/E : ovarian failure
Mycophenolate mofetil
reduce risk for treatment failure
Azathioprine
reduce risk for all-cause mortality
but, no effect on renal outcome
Bevra Hannahs Hahn. Chapter 313 - Systemic Lupus Erythematosus. Fauci et al. Harrison’s Internal Medicine. 17th ed. 2009. McGrew-Hill.
Julia B. Lewis, Eric G. Neilson. Chapter 277 - Glomerular Diseases. Fauci et al. Harrison’s Internal Medicine. 17th ed. 2009. McGrew-Hill.
G Bertsias, J P A Ioannidis, J Boletis, et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 2008 67: 195-205 originally published online May 15, 2007
Lightstone L. Lupus nephritis: where are we now?. Curr Opin Rheumatol. 2010 May;22(3):252-6.
