Jaryal Ajay, Vikrant Sanjay
Department of Nephrology, Indira Gandhi Medical College (IGMC), Shimla, India.
Indian J Med Res. 2017 Feb;145(2):167-178. doi: 10.4103/ijmr.IJMR_163_16.
Systemic lupus erythematosus (SLE) is a systemic disease of unknown aetiology with variable course and prognosis. Lupus nephritis (LN) is one of the important disease manifestations of SLE with considerable influence on patient outcomes. Immunosuppression therapy has made it possible to control the disease with improved life expectancy and quality of life. In the last few decades, various studies across the globe have clarified the role, dose and duration of immunosuppression currently in use and also provided evidence for new agents such as mycophenolate mofetil, calcineurin inhibitors and rituximab. However, there is still a need to develop new and specific therapy with less adverse effects. In this review, the current evidence of the treatment of LN and its evolution, and new classification criteria for SLE have been discussed. Also, rationale for low-dose intravenous cyclophosphamide as induction agent followed by azathioprine as maintenance agent has been provided with emphasis on individualized and holistic approach.
系统性红斑狼疮(SLE)是一种病因不明的全身性疾病,病程和预后各异。狼疮性肾炎(LN)是SLE的重要疾病表现之一,对患者的预后有相当大的影响。免疫抑制疗法使控制该病、提高预期寿命和生活质量成为可能。在过去几十年里,全球范围内的各种研究阐明了目前使用的免疫抑制的作用、剂量和疗程,也为霉酚酸酯、钙调神经磷酸酶抑制剂和利妥昔单抗等新药提供了证据。然而,仍需要开发副作用更小的新型特异性疗法。在本综述中,讨论了LN治疗的现有证据及其演变,以及SLE的新分类标准。此外,还提供了以低剂量静脉注射环磷酰胺作为诱导剂,随后以硫唑嘌呤作为维持剂的理论依据,强调个体化和整体化方法。