Consensus of the Brazilian Society of Rheumatology for the diagnosis, management and treatment of lupus nephritis

Klumb, Evandro Mendes; Silva, Clóvis A.; Lanna, Cristina Costa Duarte; Sato, Emília Inoue; Borba, Eduardo Ferreira; Brenol, João Carlos Tavares; Albuquerque, Elisa; Monticielo, Odirlei André; Costallat, Lílian Tereza Lavras; Latorre, Luiz Carlos; Sauma, Maria de Fátima Lobato da Cunha; Bonfá, Eloísa; Ribeiro, Francinne Machado

doi:10.1016/j.rbre.2014.09.010

Cited by 28 publications

(71 citation statements)

References 188 publications

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“…The most relevant issue observed by LAPR was the nonadherence of medication, in spite of high frequencies of glucorticosteroid, antimalarials, and immunosuppressive availability. Compliance is a determinant factor on cSLE outcome [26][27][28], and Brazilian Society of Rheumatology Consensus for SLE reinforced the importance to evaluate adherence in all appointments, especially for adolescents [29]. Furthermore, alcohol intake and illicit drug were also important issues evidenced in adolescents, particularly reported by LAPR in large centers.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

et al. 2018

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To assess epidemiology and management practices of Latin America Pediatric Rheumatologists (LAPR) about childhood-onset systemic lupus erythematosus (cSLE). A cross-sectional study was performed in 288 LAPR PANLAR members based on online survey about cSLE practices. The response rate of web-based survey by LAPR was 170/288(59%) and the majority worked in university hospitals (63%). The ACR and/or SLICC classification criteria (99%) and disease activity tools (97%) were almost universally used by LAPR, whereas damage index (70%) and CHAQ (58%) instruments were less frequently used. Laboratory exams, diagnostic imaging, and biopsies were generally available (> 75%), however low availability for densitometry (66%). Drug access was excellent for the most common prescribed medications (> 75%), except for belimumab (11%). Emerging mosquito-borne diseases were also reported: dengue (20%), chikungunya (11%), and Zika (8%). Groups were further divided in two, according to the median number of cSLE patients followed by LAPR in the last year: groups A and B (≥ 25 and < 25, respectively). Frequencies of condom in combination with other contraceptive methods were significantly higher in group A than B (p = 0.01). The frequencies of reported pregnancy (p < 0.001) and non-adherence to therapy were significantly higher in group A (p = 0.023). Alcohol intake (p = 0.004) and illicit drug use (p = 0.007) were also reported more frequently by LAPR of group A in at least one cSLE patient. This first large web-based survey demonstrated an overall excellent access for diagnosis and therapy by LAPR, probably related to their high rate of practices in tertiary care of university hospitals. Adherence to therapy, pregnancy, and substance abuse was identified as major challenges in this population, particularly in larger centers.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

et al. 2018

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“…Childhood-onset systemic lupus erythematosus (cSLE) is a multisystemic autoimmune and inflammatory disease that may involve any organ and system. [1][2][3][4][5][6][7] We recently reported distinct clinical and laboratory features in early-onset and adolescent groups at cSLE diagnosis in a cohort of the Sao Paulo state Brazilian Childhood-onset Systemic Lupus Erythematosus (BRAC-SLE) registry group. 8 The constellation of characteristic signs, symptoms and laboratory findings may occur serially or simultaneously during any interval of time in cSLE patients.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study

Novak

Molinari

Ferreira

et al. 2018

Lupus

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Objective The objective of this study was to compare demographic data, clinical/laboratorial features and disease activity at diagnosis in three different groups with distinct time intervals between onset of signs/symptoms and disease diagnosis. Methods A multicenter study was performed in 1555 childhood-onset systemic lupus erythematosus (American College of Rheumatology criteria) patients from 27 pediatric rheumatology services. Patients were divided into three childhood-onset systemic lupus erythematosus groups: A: short time interval to diagnosis (<1 month); B: intermediate time interval (≥1 and <3 months); and C: long time interval (≥3 months). An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2 K were evaluated. Results The number of patients in each group was: A = 60 (4%); B = 522 (33.5%); and C = 973 (62.5%). The median age at diagnosis (11.1 (4.2-17) vs. 12 (1.9-17.7) vs. 12.5 (3-18) years, P = 0.025) was significantly lower in group A compared with groups B and C. The median number of diagnostic criteria according to SLICC (7 (4-12) vs. 6 (4-13) vs. 6 (4-12), P < 0.0001) and SLEDAI-2 K (18 (6-57) vs. 16 (2-63) vs. 13 (1-49), P < 0.0001) were significantly higher in group A than the other two groups. The frequency of oral ulcers in the palate (25% vs. 15% vs. 11%, P = 0.003), pleuritis (25% vs. 24% vs. 14%, P < 0.0001), nephritis (52% vs. 47% vs. 40%, P = 0.009), neuropsychiatric manifestations (22% vs. 13% vs. 10%, P = 0.008), thrombocytopenia (32% vs. 18% vs. 19%, P = 0.037), leucopenia/lymphopenia (65% vs. 46% vs. 40%, P < 0.0001) and anti-dsDNA antibodies (79% vs. 66% vs. 61%, P = 0.01) were significantly higher in group A compared with the other groups. In contrast, group C had a less severe disease characterized by higher frequencies of synovitis (61% vs. 66% vs. 71%, P = 0.032) and lower frequencies of serositis (37% vs. 33% vs. 25%, P = 0.002), proteinuria >500 mg/day (48% vs. 45% vs. 36%, P = 0.002) and low complement levels (81% vs. 81% vs. 71%, P < 0.0001) compared with groups A or B. Conclusions Our large Brazilian multicenter study demonstrated that for most childhood-onset systemic lupus erythematosus patients, diagnosis is delayed probably due to mild disease onset. Conversely, the minority has a very short time interval to diagnosis and a presentation with a more severe and active multisystemic condition.

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“…A sua apresentação clínica é variada, com manifestações concomitantes, aditivas ou sequenciais, cíclicas ou persistentes, agudas fulminantes ou crônicas indolentes, com períodos de remissão e exacerbação relativos a órgãos e sistemas diferentes. 1,2 Atualmente, o diagnóstico de LES é baseado nos critérios do Systemic Lupus International Collaborating Clinics (SLICC, 2012), que incluem lesões renais e a anemia hemolítica autoimune (AHAI). Para suspeição ou confirmação de lúpus, de acordo com os critérios do SLICC (Quadro 1), pelo menos quatro de dezessete variáveis devem ser satisfeitas, com a necessidade de que ocorra pelo menos uma manifestação clínica associada a um critério imunológico.…”

Section: Introductionunclassified

“…1,3 O lúpus tem o comprometimento renal como uma das condições mais frequentemente relacionadas à morbimortalidade, o qual pode ser observado em até 50% dos pacientes, sendo o glomérulo o principal alvo. 2 Quase 10% dos pacientes com nefrite lúpica (NL) evoluem para doença renal crônica, com necessidade de diálise e/ou transplante. 2,3 A biópsia, quando possível, deve ser realizada, pois é capaz de identificar mínimos depósitos mesangiais de imunocomplexos.…”

Section: Introductionunclassified

Partial and simultaneous remission of nephritis and autoimmune hemolytic anemia in patients with lupus after treatment with biological agent: a case report

Fernandes¹,

Figueiredo²,

Fernandes³

et al. 2017

Medicina (Ribeirão Preto)

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O Lúpus Eritematoso Sistêmico (LES) é uma doença inflamatória crônica, sistêmica, de causa desconhecida e de natureza autoimune. Apresenta prognóstico variável, dependente do órgão ou sistema acometido, sendo o comprometimento renal uma das condições mais frequentemente relacionadas à morbimortalidade. O presente manuscrito propõe-se a contribuir como mais um indício de que o diagnóstico precoce e a terapia agressiva inicial, no lúpus, elevam sobremaneira o índice de sucesso clinico. Falhas no tratamento devem ser reconhecidas de imediato, com rápida mudança de estratégia, quando necessário. Neste sentido, uma nova opção terapêutica parece ser o agente biológico rituximab, descrito neste estudo e para o qual é dada ênfase devido à sua possível e ainda suposta capacidade de atuar como agente de resgate para a nefrite e para a anemia hemolítica lúpicas, simultaneamente, com efetividade e segurança. Apresenta-se o caso de paciente lúpica com acometimento renal e hematológico grave e refratário, que evoluiu simultaneamente com restabelecimento do débito urinário e melhora clínico-laboratorial da anemia autoimune após administração de rituximab, resposta considerada parcial, posto que a existência de dano renal persistente não pode ser descartada

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Consensus of the Brazilian Society of Rheumatology for the diagnosis, management and treatment of lupus nephritis

Cited by 28 publications

References 188 publications

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study

Partial and simultaneous remission of nephritis and autoimmune hemolytic anemia in patients with lupus after treatment with biological agent: a case report

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