Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
Autoimmun Rev. 2011 Sep;10(11):655-63. doi: 10.1016/j.autrev.2011.04.032. Epub 2011 May 1.
Although the survival of patients with lupus nephritis (LN) has improved considerably in recent years, refractory LN appears in a substantial proportion of patients and, therefore, treatment of LN remains a real challenge today. We will use the term "refractory" LN, for those cases with none or partial response to first-line therapies. In this sense, numerous epidemiological factors, including racial, socioeconomic, histological and serological parameters, may influence treatment response and, therefore, may have an impact on the outcome of renal involvement. Initial conventional therapy will depend somewhat on these epidemiological factors. If this initial therapy fails, fortunately today we have alternative therapies that include the multitarget therapy and the use of biologics. Published evidence about these therapies is presented in this review. Important terms in the management of LN, such as the definition of complete response, partial response, sustained response and renal flare as well as the discrimination of different types of flare, are also discussed here according to the European consensus statement on the terminology used in the management of lupus glomerulonephritis.
尽管近年来狼疮肾炎 (LN) 患者的生存率有了显著提高，但仍有相当一部分患者出现难治性 LN，因此，LN 的治疗仍然是当今的一个真正挑战。我们将把那些对一线治疗无反应或部分反应的病例称为“难治性”LN。在这个意义上，许多流行病学因素，包括种族、社会经济、组织学和血清学参数，可能会影响治疗反应，因此可能会对肾脏受累的结局产生影响。初始的常规治疗在某种程度上取决于这些流行病学因素。如果初始治疗失败，幸运的是，我们现在有替代疗法，包括多靶点治疗和生物制剂的使用。本文就这些疗法的已发表证据进行了综述。根据欧洲狼疮肾炎管理术语共识声明，本文还讨论了 LN 管理中的一些重要术语，如完全缓解、部分缓解、持续缓解和肾脏复发，以及不同类型复发的鉴别。
