Current Strategy of Management for Lupus Nephritis and Renal Vasculitis
Current strategy of management for lupus nephritis and renal vasculitis has been considered from clinical, morphologic, and immunologic points of view. In the immunologically active and rapidly progressive type of lupus nephritis, short-term intensive immunosuppressive therapy is recommended. However, in chronically ill patients with no flare-up of immunologic activity, long term corticosteroid administration is not recommended, especially in those patients with WHO type 5 histology. In rapidly progressive lupus nephritis, early initiation of hemodialysis is recommended, together with intensive immunosuppressive therapy, including plasma exchange. In patients on chronic hemodialysis without flare-up of immunologic activity (burning out systemic lupus erythematosus (SLE)), renal transplantation is indicated.
For the monitoring of immunosuppressive therapy in renal vasculitis, serial quantitative measurements of anti-neutrophil cytoplasmic antibodies are needed.
KeywordsCorticosteroid Thrombocytopenia Proteinuria Vasculitis Nephritis
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