Okpechi I G, Ameh O I
S Afr Med J. 2015 Dec;105(12):1071-4. doi: 10.7196/samj.2015.v105i12.10224.
Lupus nephritis (LN) is a significant cause of morbidity and mortality in patients with systemic lupus erythematosus. Delayed recognition and diagnosis of LN may be a common cause of chronic kidney disease among South Africans. Renal biopsy is the gold standard of diagnosing LN; however, this service is not available in many centres and the use of urinalysis, urine microscopic examination and other serological tests can be useful in identifying patients with proliferative LN. Proliferative types of LN (class III, class IV and mixed class V)comprise the larger proportion of patients with this condition. Patients receiving immunosuppressive therapy need to be monitored closely for side-effects and drug-related toxicities. LN patients with end-stage renal disease (class VI) need to be prepared for renal replacement therapy (dialysis and renal transplantation). In all patients, treatment should include adjunctive therapies such as renin angiotensin aldosterone system blockade, bone protection (with calcium supplements and vitamin D), blood pressure control and chloroquine–all of which help to retard the progression of kidney disease.
狼疮性肾炎（LN）是系统性红斑狼疮患者发病和死亡的重要原因。LN的诊断延迟可能是南非慢性肾脏病的常见病因。肾活检是诊断LN的金标准；然而，许多中心无法提供此项检查，而尿液分析、尿显微镜检查和其他血清学检查在识别增殖性LN患者方面可能有用。增殖性LN类型（III类、IV类和混合V类）在该病患者中占较大比例。接受免疫抑制治疗的患者需要密切监测副作用和药物相关毒性。终末期肾病（VI类）的LN患者需要为肾脏替代治疗（透析和肾移植）做好准备。对于所有患者，治疗应包括辅助治疗，如肾素-血管紧张素-醛固酮系统阻断、骨保护（补充钙和维生素D）、血压控制和氯喹，所有这些都有助于延缓肾病进展。
