Lupus Lupus Lupus #NKFClinicals
Dr Jeyabalan from MGH on the wealth of new data in LN and SLE #NKFClinicals
50% of SLE with renal involvement
5-20% of LN develop ESRD
10 year survival goes from 46 to 95% if disease remission is achieved #NKFClinicals
5-20% of LN develop ESRD
10 year survival goes from 46 to 95% if disease remission is achieved #NKFClinicals
Though there are 6 pathological classes we really only care about Class 3 and Class 4. Class 5 🙃
Shows some light microscopy, EM, and IF images. #NKFClinicals
Shows some light microscopy, EM, and IF images. #NKFClinicals
Presents classic SLE with box revealing combined WHO Class 4 and 5 #NKFClinicals
How to treat?
Everyone gets hydroxychloroquine and RAASi
Class 1 and 2, treat as MCD if nephrotic, otherwise target extra-renal manifestations #NKFClinicals
Everyone gets hydroxychloroquine and RAASi
Class 1 and 2, treat as MCD if nephrotic, otherwise target extra-renal manifestations #NKFClinicals
How to treat class 4 and 5:
Induce with steroids then…
Induce with steroids then…
2002 Euro-Lupus Trial from 2002 low dose vs high dose cyclophosphamide. Renal remission in 71% with low dose and 54% with high dose, no NS difference. #NKFClinicals
ALMS trial of MMF vs IV cyclophosphamide. No difference in renal response (50% decrease in proteinuria and stable Cr), 56 with MMF and 53% with CYT. #NKFClinicals
JASN 2008 Hao Bao CYT vs MMF and tacro and steroids. The second was called multitarget therapy. The multitarget therapy was better, but similar to other control groups so 🤷♂️. #NKFClinicals
Cochran review showed rate of ESRD similar with MMF vs CYT. So probably look at patient/physician pref/cost/side effects. #NKFClinicals
USE LESS STEROIDS! #NKFClinicals
MMF is superior to azathioprine for maintenance of LN (prevents relapse). #NKFClinicals
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