Clinical approach to lupus nephritis: Recent advances

Molino, Christian; Fabbian, Fabio; Longhini, C

doi:10.1016/j.ejim.2008.12.018

Cited by 36 publications

(34 citation statements)

References 62 publications

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“…Rituximab is a monoclonal antibody directed against CD20 that is being studied for use in SLE and LN (86,87). Because data regarding its safety in pregnancy are lacking, rituximab should be avoided until its safety and efficacy have been demonstrated.…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary SLE is a multi-organ autoimmune disease that affects women of childbearing age. Renal involvement in the form of either active lupus nephritis (LN) at the time of conception, or a LN new onset or flare during pregnancy increases the risks of preterm delivery, pre-eclampsia, maternal mortality, fetal/neonatal demise, and intrauterine growth restriction. Consequently, current recommendations advise that the affected woman achieve a stable remission of her renal disease for at least 6 months before conception. Hormonal and immune system changes in pregnancy may affect disease activity and progression, and published evidence suggests that there is an increased risk for a LN flare during pregnancy. The major goal of immunosuppressive therapy in pregnancy is control of disease activity with medications that are relatively safe for a growing fetus. Therefore, the use of mycophenolate mofetil, due to increasing evidence supporting its teratogenicity, is contraindicated during pregnancy. Worsening proteinuria, which commonly occurs in proteinuric renal diseases toward the end of pregnancy, should be differentiated from a LN flare and/or preeclampsia, a pregnancy-specific condition clinically characterized by hypertension and proteinuria. These considerations present challenges that underscore the importance of a multidisciplinary team approach when caring for these patients, including a nephrologist, rheumatologist, and obstetrician who have experience with these pregnancyrelated complications. This review discusses the pathogenesis, maternal and fetal risks, and management pertinent to SLE patients with new onset or a history of LN predating pregnancy.

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Section: Immunosuppressive Therapymentioning

confidence: 99%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…While the opinion of rheumatology was for seronegative lupus, the nephrology service favored ''lupuslike'' glomerulonephritis from HCV, but treatment of acute glomerulonephritis with either primary diagnosis is similar. In rapidly progressive glomerulnephritides, oral cyclophosphamide along with corticosteroid therapy is often part of the initial treatment [22,23]. However, adverse effects of corticosteroid therapy are well known, and cyclophosphamide toxicity may result in hepatotoxicity or leukopenia with a resultant increased risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Lupus-like glomerulonephritis: an autoimmune complication of hepatitis C infection

Hobeika

Srivastava

et al. 2012

CEN Case Rep

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“…Current therapies for severe forms of lupus nephritis are various combinations of corticosteroids with other cytotoxic agents or immunomodulators, such as cyclophosphamide, azathioprine, or cyclosporin (6,41,69), but many of these have various side effects (16,28). The immunomodulatory activity of various traditional Chinese medicinal herbs is now widely acknowledged (35).…”

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confidence: 99%

Therapeutic potential of DCB-SLE1, an extract of a mixture of Chinese medicinal herbs, for severe lupus nephritis

Tsai

Ka²,

Chang³

et al. 2011

American Journal of Physiology-Renal Physiology

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. Therapeutic potential of DCB-SLE1, an extract of a mixture of Chinese medicinal herbs, for severe lupus nephritis. Am J Physiol Renal Physiol 301: F751-F764, 2011. First published June 15, 2011 doi:10.1152/ajprenal.00706.2010.-The pathogenesis of lupus nephritis is mainly attributable to a complex interaction between the innate and adaptive immune systems, including T and B cell function abnormalities. In addition to autoantibody production and immune complex deposition, Th1 and Th17 cytokines may play key roles in the development and progression of lupus nephritis. Acute onset of severe lupus nephritis remains a challenge in terms of prevention and treatment. In the present study, we evaluated the therapeutic effects of DCB-SLE1, an extract of a mixture of four traditional Chinese medicinal herbs (Atractylodis macrocephalae Rhizoma, Eucommiae cortex, Lonicerae caulis, and Hedyotidis diffusae Herba), on an accelerated severe lupus nephritis model, characterized by acute onset of proteinuria, azotemia, autoantibody production, and development of severe nephritis, induced by twice weekly injection of New Zealand black/white F1 mice with Salmonella-type lipopolysaccharide. DCB-SLE1 was administered daily by gavage starting 2 days after the first dose of induction of lipopolysaccharide, and the mice were euthanized at week 1 or week 5. The results showed that DCB-SLE1 significantly ameliorated the hematuria, proteinuria, renal dysfunction, and severe renal lesions by 1) suppression of B cell activation and decreased autoantibody production; 2) negative regulation of T cell activation/proliferation and natural killer cell activity; 3) suppression of IL-18, IL-6, and IL-17 production and blocking of NF-B activation in the kidney; and 4) prevention of lymphoid and renal apoptosis. These results show that DCB-SLE1 can protect the kidney from autoimmune response-mediated acute and severe damage through systemic immune modulation and anti-inflammation pathways.hematuria; proteinuria; natural killer cell; IL-17; IL-18

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Clinical approach to lupus nephritis: Recent advances

Cited by 36 publications

References 62 publications

Obstetric Nephrology

Obstetric Nephrology

Lupus-like glomerulonephritis: an autoimmune complication of hepatitis C infection

Therapeutic potential of DCB-SLE1, an extract of a mixture of Chinese medicinal herbs, for severe lupus nephritis

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