Consenso da Sociedade Brasileira de Reumatologia para o diagnóstico, manejo e tratamento da nefrite lúpica

Abstract

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.

Alterações retrococleares na esclerose sistêmica: relato de casos

“…However, studies conducted with patients with systemic lupus erythematosus -another rheumatologic disease in which vasculopathy may occur, reported 6.7% of patients with altered BAEP results. Systemic lupus erythematosus presents secondary vasculopathy, less important than that observed in SSc, but sufficient to lead to retrocochlear impairments, suggesting that the significant vascular impairment characteristic of SSc can lead to auditory neuropathy in patients (23,24) .…”

Understanding and Managing Pregnancy in Patients with Lupus

“…LN is likely to be associated with positive anti-dsDNA antibodies (especially in high titers), serum complement consumption, and dysmorphic hematuria and/or red blood cell cylinders. In this scenario, the probable diagnosis is a proliferative kidney disease [ 59 ]. During clinical evaluation, the onset of fever, presence of discoid or subacute cutaneous lupus lesions, vasculitis, oral ulcers, polyserositis, lymphadenomegaly, positive direct Coombs, myocarditis, and pneumonitis also indicate lupus flare.…”

Effectiveness of pharmaceutical care for drug treatment adherence in patients with systemic lupus erythematosus in Rio de Janeiro, Brazil: study protocol for a randomized controlled trial

“…They will receive the medical care routinely offered by the institution (centered on the medical team), which consists of clinical follow-up and counseling on the disease and its drug treatment. The number of appointments per patient will not be predefined in both groups, but will be determined by the patient’s attending rheumatologist, based on clinical assessment and SLE treatment guidelines [ 39 – 41 ].…”