Inda-Filho Antonio, Neugarten Joel, Putterman Chaim, Broder Anna
Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Semin Dial. 2013 Sep-Oct;26(5):590-6. doi: 10.1111/sdi.12122. Epub 2013 Sep 4.
The development of lupus-related end-stage renal disease (ESRD) confers the highest mortality rates among individuals with lupus. Lupus-related ESRD is also associated with higher morbidity and mortality rates compared with non-lupus ESRD. We review the evidence that persistent lupus activity, hypercoagulability, and continuing immunosuppression may contribute to unfavorable outcomes in dialysis and renal transplantation among lupus patients. Robust epidemiologic studies are needed to develop individualized evidence-based approaches to treating lupus-related ESRD. In the meantime, managing lupus-related ESRD presents a significant challenge for clinicians and requires a team approach involving nephrologists and rheumatologists. Goals of therapy after developing ESRD should include continuing monitoring of lupus activity, minimizing corticosteroid exposure, and choosing the most appropriate renal replacement therapy based on patient's risk profile and quality-of-life considerations.
狼疮相关终末期肾病（ESRD）的发展在狼疮患者中导致最高的死亡率。与非狼疮性ESRD相比，狼疮相关ESRD还与更高的发病率和死亡率相关。我们回顾了相关证据，即持续性狼疮活动、高凝状态和持续免疫抑制可能导致狼疮患者透析和肾移植的不良结局。需要开展有力的流行病学研究，以制定针对狼疮相关ESRD的个体化循证治疗方法。与此同时，管理狼疮相关ESRD对临床医生而言是一项重大挑战，需要肾病学家和风湿病学家的团队协作。ESRD发生后的治疗目标应包括持续监测狼疮活动、尽量减少皮质类固醇暴露，并根据患者的风险状况和生活质量考虑选择最合适的肾脏替代治疗。
