Lupus low disease activity state as a treatment target for pediatric patients with lupus nephritis

Kısaoğlu, Hakan; Baba, Özge; Kalyoncu, Mukaddes

doi:10.1007/s00467-022-05742-8

Cited by 9 publications

(2 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, lupus low disease activity (LLDAS) has recently been recognized as a valid predictor of low rates of kidney flares and damage accrual in pediatric LN [218]. LLDAS is defined as SLEDAI ≤ 4; absence of SLEDAI-based activity in major organ systems and hemolytic anemia or gastrointestinal activity; no new disease activity, either clinical or serological; physician global assessment (PGA) scale ≤ 1; prednisone dose ≤ 7.5 mg/day.…”

Section: Follow-up and Prognosismentioning

confidence: 99%

Lupus Nephritis in Children: Novel Perspectives

Pennesi,

Benvenuto

2023

Medicina

View full text Add to dashboard Cite

Childhood-onset systemic lupus erythematosus is an inflammatory and autoimmune condition characterized by heterogeneous multisystem involvement and a chronic course with unpredictable flares. Kidney involvement, commonly called lupus nephritis, mainly presents with immune complex-mediated glomerulonephritis and is more frequent and severe in adults. Despite a considerable improvement in long-term renal prognosis, children and adolescents with lupus nephritis still experience significant morbidity and mortality. Moreover, current literature often lacks pediatric-specific data, leading clinicians to rely exclusively on adult therapeutic approaches. This review aims to describe pediatric lupus nephritis and provide an overview of the novel perspectives on the pathogenetic mechanisms, histopathological classification, therapeutic approach, novel biomarkers, and follow-up targets in children and adolescents with lupus nephritis.

show abstract

Section: Follow-up and Prognosismentioning

confidence: 99%

Lupus Nephritis in Children: Novel Perspectives

Pennesi,

Benvenuto

2023

Medicina

View full text Add to dashboard Cite

show abstract

“…Circumstantial evidence suggests that persistent SLE activity can precipitate a flare from a major organ such as the kidney [32] or the central nervous system [43]. Notably, a study in pediatric LN cases showed that achievement of lupus low disease activity state (LLDAS, an established treatment target for general SLE [44]) after initial treatment and LLDAS-50 (i.e., LLDAS attained for at least 50% of the total observation period) were both associated with significantly lower rates of kidney flare [45]. Importantly, due to the advent of novel biological treatments such as belimumab, management of extra-renal disease activity may not necessarily mandate the use of glucocorticoids at high dose or for prolonged periods of time.…”

Section: Extra-renal Lupus Activitymentioning

confidence: 99%

Flares in Lupus Nephritis: Risk Factors and Strategies for Their Prevention

Banos

Βertsias

2023

Curr Rheumatol Rep

View full text Add to dashboard Cite

Purpose of Review Discuss the prognostic significance of kidney flares in patients with lupus nephritis, associated risk factors, and possible preventative strategies. Recent Findings Recently performed clinical trials and observational cohort studies underscore the high frequency of relapses of kidney disease, following initial response, in patients with proliferative and/or membranous lupus nephritis. Analysis of hard disease outcomes such as progression to chronic kidney disease or end-stage kidney disease, coupled with histological findings from repeat kidney biopsy studies, have drawn attention to the importance of renal function preservation that should be pursued as early as lupus nephritis is diagnosed. In this respect, non-randomized and randomized evidence have suggested a number of factors associated with reduced risk of renal flares such as attaining a very low level of proteinuria (< 700–800 mg/24 h by 12 months), using mycophenolate over azathioprine, adding belimumab to standard therapy, maintaining immunosuppressive/biological treatment for at least 3 to 5 years, and using hydroxychloroquine. Other factors that warrant further clarification include serological activity and the use of repeat kidney biopsy to guide the intensity and duration of treatment in selected cases. Summary The results from ongoing innovative studies integrating kidney histological and clinical outcomes, together with an expanding spectrum of therapies in lupus nephritis, are expected to facilitate individual medical care and long-term disease and patient prognosis.

show abstract