Nierenbeteiligung bei Kollagenosen - Teil 1: Lupus-Nephritis
Oelzner P, Amann KU, Wolf G (2020)
Publication Type: Journal article
Publication year: 2020
Journal
Book Volume: 45
Pages Range: 150-162
Journal Issue: 2
DOI: 10.1055/a-1117-2920
Abstract
Lupus nephritis (LN) occurs dependent on ethnicity and gender in up to 50% of patients with systemic lupus erythematosus (SLE) and represents the prognostic most important organ manifestation in SLE. Pathogenetic important aspects of SLE are a multifactorial caused disturbance of the clearance of autoantigen released in the context of apoptosis and NETosis resulting in the development of autoimmune reaction, an amplification of the pathologic immune reaction by hyperactivation of type I-interferon signaling and cytokine imbalance. The pathogenetic process in the kidney results in immune complex glomerulonephritis. Early diagnosis and initiation of therapy are of critical importance for the prognosis of LN. The selection of therapy is based principally on the findings in renal biopsy. In the case of proliferative LN (class III or IV, also in combination with membranous LN) a remission induction with low-dose cyclophosphamide (CYC)-pulse therapy (6 x 500 mg) or with mycophenolatofetil (MMF) in combination with initial high dose glucocorticoids (GC) is followed by a maintenance therapy with azathioprine or MMF. In refractory situations a switch from CYC to MMF or conversely is indicated. Alternatively rituximab or calcineurin inhibitors can also be used. In other forms of LN the therapeutic procedure is essentially determinated by the course of renal function and the extent of proteinuria. In addition supportive procedures such as the general use of hydroxychloroquine, ACE inhibitors or angiotensin rezeptor blockers in dependence of the extent of proteinuria and of blood pressure and prophylactic measures to prevent thromboembolism, osteoporosis and infections come into use. Aims of therapy are a preferably complete renal remission, prevention of chronic damage and an effective reduction of GC dose. A complete remission which is defined by the preservation of normal renal function and a substantial reduction of proteinuria is achieved in approximately 50-60%. This underlines the effectiveness of the curent therapy on one hand but illuminates the need of new therapeutic strategies on the other, especially in view of the high rate of damage. New therapeutic approaches such multitarget therapy, new protocolls of B cell depletion and B cell neutralization and GC free treatment principles aim at a more effective and side effect poor therapy of LN.
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APA:
Oelzner, P., Amann, K.U., & Wolf, G. (2020). Nierenbeteiligung bei Kollagenosen - Teil 1: Lupus-Nephritis. Aktuelle Rheumatologie, 45(2), 150-162. https://doi.org/10.1055/a-1117-2920
MLA:
Oelzner, Peter, Kerstin Ute Amann, and Gunter Wolf. "Nierenbeteiligung bei Kollagenosen - Teil 1: Lupus-Nephritis." Aktuelle Rheumatologie 45.2 (2020): 150-162.
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