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Rev Bras Reumatol. 2015 Jan-Feb;55(1):1-21. doi: 10.1016/j.rbr.2014.09.008. Epub 2014 Nov 1.

[Consensus of the Brazilian Society of Rheumatology for the diagnosis, management and treatment of lupus nephritis].

[Article in Portuguese]

Author information

1
Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. Electronic address: klumb@uol.com.br.
2
Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
3
Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
4
Disciplina de Reumatologia, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
5
Disciplina de Reumatologia da Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
6
Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
7
Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
8
Disciplina de Reumatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
9
Disciplina de Reumatologia, Faculdade de Medicina, Universidade Estadual de Campinas, Campinas, SP, Brasil.
10
Serviço de Reumatologia, Hospital de Heliópolis, São Paulo, SP, Brasil.
11
Disciplina de Reumatologia, Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brasil.

Abstract

OBJECTIVE:

To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil.

METHOD:

Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology.

RESULTS AND CONCLUSIONS:

1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. 2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. 3) Risks and benefits of treatment should be shared with the patient and his/her family. 4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. 5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). 6) ACE inhibitors and/or ARBs are recommended as antiproteinuric agents for all patients (unless contraindicated). 7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including steroids and an immunosuppressive agent, even though histological confirmation is not possible. 8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient achieve and maintain a sustained and complete remission. 9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when a new renal biopsy should be considered to assist in identifying the cause of refractoriness and in the therapeutic decision.

KEYWORDS:

Brasil; Brazil; Consenso; Consensus; Lupus nephritis; Lúpus eritematoso sistêmico; Nefrite lúpica; Systemic lupus erythematous; Terapêutica; Therapeutics

PMID:
25595733
DOI:
10.1016/j.rbr.2014.09.008
[Indexed for MEDLINE]
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