Santos-Araújo Carla, Pestana Manuel
Serviço de Nefrologia, Hospital de S. João/Faculdade de Medicina do Porto, Porto.
Acta Med Port. 2008 May-Jun;21(3):259-72. Epub 2008 Jul 25.
Systemic lupus erithematosus (SLE) is a multiorganic inflammatory disease characterized by a significant morbidity and mortality related not just to disease evolution but also to therapeutic side effects. Sixty percent of SLE patients develop renal disease related to lupus. Moreover, several studies report that lupus nephritis is an important predictor of both renal impairment and global mortality in these patients. In lupus nephritis, the renal biopsy still represents a cornerstone for both histological grading and therapeutical management. Several classification schemes for lupus nephritis based mainly on morphological parameters have been proposed so far. In the WHO grading system the most severe form of lupus nephritis is the diffuse proliferative lupus nephritis or lupus nephritis class IV. In fact, several authors have documented an invariable course to end stage renal failure in these patients, in the absence of specific therapy. Despite the considerable improvement observed since the introduction of corticosteroid and cyclophosphamide treatment, a significant number of patients still present an incomplete response to therapy. Moreover, even in the cases of good response to therapy adverse events related to the treatment such as infertility, hemorrhagic cystitis or increased susceptibility to infection frequently supervenes.
系统性红斑狼疮（SLE）是一种多器官炎症性疾病，其发病率和死亡率不仅与疾病进展有关，还与治疗副作用相关。60%的SLE患者会出现与狼疮相关的肾脏疾病。此外，多项研究报告称，狼疮性肾炎是这些患者肾功能损害和总体死亡率的重要预测指标。在狼疮性肾炎中，肾活检仍然是组织学分级和治疗管理的基石。迄今为止，已经提出了几种主要基于形态学参数的狼疮性肾炎分类方案。在世界卫生组织（WHO）分级系统中，最严重的狼疮性肾炎形式是弥漫性增殖性狼疮性肾炎或IV级狼疮性肾炎。事实上，一些作者记录了在没有特异性治疗的情况下，这些患者最终会不可避免地发展为终末期肾衰竭。尽管自引入皮质类固醇和环磷酰胺治疗以来观察到了相当大的改善，但仍有相当数量的患者对治疗反应不完全。此外，即使在治疗反应良好的情况下，与治疗相关的不良事件，如不孕症、出血性膀胱炎或感染易感性增加也经常出现。
