Lupus Nephritis Screening and Management Guidelines Issued

Include methods for identifying disease, new therapies, and treatment of pregnant patients

FRIDAY, May 4 (HealthDay News) -- The American College of Rheumatology has produced new guidelines for the screening, treatment, and management of lupus nephritis; the guidelines have been published in the June issue of Arthritis Care & Research.

Bevra H. Hahn, M.D., from the University of California in Los Angeles, and colleagues from the American College of Rheumatology conducted a systematic literature review to update guidelines on the management of lupus nephritis. The strength of evidence was graded and recommendations for the treatment and monitoring of lupus nephritis were developed.

The authors' recommendations include advising renal biopsy in previously untreated patients to classify disease; treatment should be based in part on this classification. Adjunctive treatments include background therapy with hydroxychloroquine, blockade of the renin-angiotensin system, and control of blood pressure to a goal of 130/80 mm Hg or lower. Induction of improvement is recommended for specific patients. For patients who are responsive to induction therapy, the improvement should be maintained (with azathioprine or mycophenolate mofetil), and therapies should be changed for patients who are not adequately responsive to induction therapy. For patients with renal abnormalities, vascular disease should be identified. Women with child-bearing potential should be advised regarding disease-specific risks.

"Nephritis remains one of the most devastating complications of lupus, with the incidence of end-stage renal disease due to lupus increasing between 1982 and 1995, without any decline seen by 2004," the authors write. "We hope that institution of these recommendations might lead to reductions in these trends."

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

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