KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS

Network pharmacology and molecular docking to elucidate the common mechanism of hydroxychloroquine treatment in lupus nephritis and IgA nephropathy

“…HCQ has been recommended for the treatment of LN and IgAN in KDIGO 2024 guideline. 4 The current study found that HCQ might play an important role in the treatment of LN and IgAN via a common mechanism, evidenced by its effect on MMP2, PPARG, IL-2, MAPK14, MMP9, and SRC.…”

“…3 KDIGO guidelines and several medical organizations (including the European League Against Rheumatism, as well as the European Renal Association-European Dialysis and Transplant Association) guide that current treatment for LN is mainly based on integrated use of antimalarial drugs (mainly HCQ), glucocorticoids, and immunosuppressive drugs. 4,5 Several large clinical studies have suggested that HCQ can play a protective role against LN, including enhanced treatment response, decreased renal attack rate, and decreased progression rate of renal failure in LN patients. 6,7 Immunoglobulin A nephropathy (IgAN) is a quite common form of primary glomerulonephritis worldwide.…”

“…12 Currently, the KDIGO guidelines have recommended HCQ as a conventional treatment for IgAN. 4 For example, a study showed that HCQ could effectively improve kidney injury by reducing the immune complex deposition of IgA and IgG in the glomeruli of IgAN rats. 13 Till now, the wide use of HCQ in the treatment of LN and IgAN has achieved good clinical results.…”

Correspondence on ‘EULAR recommendations for the management of systemic lupus erythematosus: 2023 update’ by Fanouriakis et al

“…The presence of residual albuminuria labels a patient as having chronic kidney disease (CKD) and this nomenclature of CKD has also been incorporated into the KDIGO 2024 Clinical Practice Guideline for the management of LN. 6 Indeed, individuals with LN and established CKD had an annualised eGFR decline of 4.4 mL/min/1.73 m 2 in comparison to a decline of 0.7 mL/ min/1.73 m 2 of patients with SLE with a comparable eGFR but without LN. 7 The relevance of such a progressive decline in eGFR has been studied in the Hopkins Lupus Cohort comprising 2528 patients with SLE.…”

Systemischer Lupus Erythematodes 2023

“…Dies bezieht sich explizit auf die immunsuppressive Therapie und Biologika, da GC zu dem Zeitpunkt bereits ausgeschlichen sein sollten. Hydroxychloroquin sollte hingegen, außer bei relevanten unerwünschten Wirkungen, nicht abgesetzt werden, da das Absetzen in Beobachtungsstudien mit einem erhöhten Schubrisiko assoziiert war[19]. Auch das Ausschleichen sollte mit Blick auf Patientencharakteristika, frühere Organmanifestationen, Verträglichkeit und Patientenpräferenz stets individuell entschieden werden.…”