Kidney involvement in systemic lupus erythematosus: From the patient assessment to a tailored treatment.

IF 4.5 2区 医学 Q1 RHEUMATOLOGY Best Practice & Research in Clinical Rheumatology Pub Date : 2023-12-01 Epub Date: 2023-12-26 DOI:10.1016/j.berh.2023.101925
Juan M Mejia-Vilet, Tabitha Turner-Stokes, Frederic Houssiau, Brad H Rovin
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引用次数: 0

Abstract

In the last few years, several studies have provided new evidence for the diagnosis, management, and follow-up of patients with lupus nephritis. Evidence showing dissociation between clinical and histological findings has prompted reevaluation of the role of the kidney biopsy as a tool for diagnosis and follow-up. In therapeutics, four immunosuppressive schemes now have supporting evidence for use as initial therapy. Current challenges include individualized selection of the best immunosuppressive regimen, an unmet need for non-invasive biomarkers of disease activity to inform treatment responses and guide subsequent therapy, holistic patient management in this complex, multisystem disease, and ultimately the development of more targeted therapies directed at specific effector pathways driving glomerular inflammation and damage in order to improve treatment response. In this communication, we review the diagnostic and therapeutic approach to lupus nephritis, as well as evaluation of response to therapy and disease control.

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系统性红斑狼疮的肾脏受累:从患者评估到针对性治疗。
过去几年中,一些研究为狼疮肾炎患者的诊断、管理和随访提供了新的证据。有证据显示临床和组织学检查结果之间存在差异,这促使人们重新评估肾活检作为诊断和随访工具的作用。在治疗方面,目前有四种免疫抑制方案有证据支持作为初始疗法使用。目前面临的挑战包括:最佳免疫抑制方案的个体化选择、对非侵入性疾病活动生物标志物的需求尚未得到满足,而这些生物标志物可为治疗反应提供信息并指导后续治疗、在这种复杂的多系统疾病中对患者进行整体管理,以及最终针对驱动肾小球炎症和损伤的特定效应通路开发更具针对性的疗法,以改善治疗反应。在这篇通讯中,我们回顾了狼疮性肾炎的诊断和治疗方法,以及对治疗反应和疾病控制的评估。
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来源期刊
CiteScore
9.40
自引率
0.00%
发文量
43
审稿时长
27 days
期刊介绍: Evidence-based updates of best clinical practice across the spectrum of musculoskeletal conditions. Best Practice & Research: Clinical Rheumatology keeps the clinician or trainee informed of the latest developments and current recommended practice in the rapidly advancing fields of musculoskeletal conditions and science. The series provides a continuous update of current clinical practice. It is a topical serial publication that covers the spectrum of musculoskeletal conditions in a 4-year cycle. Each topic-based issue contains around 200 pages of practical, evidence-based review articles, which integrate the results from the latest original research with current clinical practice and thinking to provide a continuous update. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. The review articles seek to address the clinical issues of diagnosis, treatment and patient management. Management is described in practical terms so that it can be applied to the individual patient. The serial is aimed at the physician in both practice and training.
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