European consensus statement on the terminology used in the management of lupus glomerulonephritis (original) (raw)
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Journal of nephropathology, 2014
Implication for health policy/practice/research/medical education: Lupus nephritis (LN) is the most dreadful complication of systemic lupus erythematosus (SLE) and is responsible for the major share of morbidity and mortality of this disease. Its diagnosis, classification and management have posed significant challenges to the nephrologists and pathologists over the past several decades. A series of WHO classifications of LN were followed by the development of the international society of nephrology/renal pathology society (ISN/RPS) classification of LN in 2003. The classification has largely succeeded in achieving its goals, but a few limitations have also been exposed. It is time to revisit the classification in the light of experience of validation studies and new emerging data on this disease.
J Nephropathol, 2014
Lupus nephritis (LN) is the most dreadful complication of systemic lupus erythematosus (SLE) and is responsible for the major share of morbidity and mortality of this disease. Its diagnosis, classification and management have posed significant challenges to the nephrologists and pathologists over the past several decades. A series of WHO classifications of LN were followed by the development of the international society of nephrology/renal pathology society (ISN/RPS) classification of LN in 2003. The classification has largely succeeded in achieving its goals, but a few limitations have also been exposed. It is time to revisit the classification in the light of experience of validation studies and new emerging data on this disease. Please cite this paper as: Mubarak M, Nasri H. ISN/RPS 2003 classification of lupus nephritis: time to take a look on the achievements and limitations of the schema.
Lupus nephritis management guidelines compared
Nephrology Dialysis Transplantation, 2015
Keywords (max 5): systemic lupus erythematosus, lupus nephritis, treatment, guideline, management Word count manuscript (including abstract, excluding tables): 3793 Number of tables: 3 Number of supplemental tables: 3 Number of references: 55
Classifying Lupus Nephritis: An Ongoing Story
The Scientific World Journal, 2014
The role of the renal biopsy in lupus nephritis is to provide the diagnosis and to define the parameters of prognostic and therapeutic significance for an effective clinicopathological correlation. Various classification schemas initiated by World Health Organization in 1974 have been proposed until the most recent update by International Society of Nephrology/Renal Pathology Society in 2004. In this paper, we reviewed the new classification system with the associated literature to highlight the benefits and the weak points that emerged so far. The great advantage of the classification emerged to provide a uniform reporting for lupus nephritis all over the world. It has provided more reproducible results from different centers. However, the studies indicated that the presence of glomerular necrotizing lesion was no longer significant to determine the classes of lupus nephritis leading to loss of pathogenetic diversity of the classes. Another weakness of the classification that also ...
Kidney international, 2018
We present a consensus report pertaining to the improved clarity of definitions and classification of glomerular lesions in lupus nephritis that derived from a meeting of 18 members of an international nephropathology working group in Leiden, Netherlands, in 2016. Here we report detailed recommendations on issues for which we can propose adjustments based on existing evidence and current consensus opinion (phase 1). New definitions are provided for mesangial hypercellularity and for cellular, fibrocellular, and fibrous crescents. The term "endocapillary proliferation" is eliminated and the definition of endocapillary hypercellularity considered in some detail. We also eliminate the class IV-S and IV-G subdivisions of class IV lupus nephritis. The active and chronic designations for class III/IV lesions are replaced by a proposal for activity and chronicity indices that should be applied to all classes. In the activity index, we include fibrinoid necrosis as a specific desc...
Annals of the Rheumatic Diseases, 2012
ObjectivesTo develop recommendations for the management of adult and paediatric lupus nephritis (LN).MethodsThe available evidence was systematically reviewed using the PubMed database. A modified Delphi method was used to compile questions, elicit expert opinions and reach consensus.ResultsImmunosuppressive treatment should be guided by renal biopsy, and aiming for complete renal response (proteinuria <0.5 g/24 h with normal or near-normal renal function). Hydroxychloroquine is recommended for all patients with LN. Because of a more favourable efficacy/toxicity ratio, as initial treatment for patients with class III–IVA or A/C (±V) LN according to the International Society of Nephrology/Renal Pathology Society 2003 classification, mycophenolic acid (MPA) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. In patients with adverse clinical or histological features, CY can be prescribed at higher doses, while azathioprine is an alterna...
Egyptian Rheumatology and Rehabilitation
Background Lupus nephritis (LN) affects a substantial number of the patients living with Systemic lupus erythematosus (SLE), representing a major cause of morbidity and mortality. Patients with lupus nephritis should be referred to a lupus nephritis expert who can confirm the diagnosis, assess the level of disease activity, and offer guidance on treatment and monitoring of the disease, as well as its consequences and side effects. The aim of this guideline was to develop recommendations for the management of adult lupus patients, including lupus nephritis diagnosis, assessment, and monitoring. Nineteen key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for LN. Subsequently, recommendations were formulated. T...