Abstract
Renal involvement is frequent (20 to 50% of cases) during the course of systemic lupus erythematosus (SLE). It significantly influences the functional prognosis and the patient survival. Glomerulopathy is the usual renal lesion in SLE and the clinical presentation can be very polymorphic, ranging from isolated proteinuria to nephrotic syndrome or rapidly progressive renal failure. The severity of the renal disease and the overall prognosis can vary according to the patient's ethnicity but the main prognostic factor is the response of the disease to the initial immunosuppressive therapy. Renal biopsy is essential for classifying the glomerular lesions, establish the prognosis and guide the clinician in the choice of the right therapeutic scheme. The induction therapy of lupus proliferative glomerulonephritis asssociates high-dose corticosteroids and an immunosuppressive treatment. Cyclophosphamide and mycophenolate mofetil (MMF) are the most used immunosuppressive drugs in this setting. After remission, the treatment is classically switched to a combination of low-dose corticosteroids and oral immunosuppression with azathioprine or MMF, combined with long-term hydroxychloroquine prophylaxis.
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