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首页> 外文期刊>Nature clinical practice. Rheumatology >Update on the management of lupus nephritis: let the treatment fit the patient.
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Update on the management of lupus nephritis: let the treatment fit the patient.

机译：狼疮性肾炎治疗的最新进展：让治疗适合患者。

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The introduction of new therapeutic modalities, such as biologic agents, for the treatment of lupus nephritis has re-energized research into this disorder, enabling investigators to formulate evidence-based recommendations. Thus, it is now widely accepted that the management of lupus nephritis involves a period of intensive induction therapy, followed by a longer period of less-intensive maintenance therapy. Risk stratification, based on histologic, demographic, clinical and laboratory characteristics, allows the identification of patients at high risk of renal dysfunction, for whom aggressive therapy is likely to be the most beneficial. New studies and meta-analyses comparing mycophenolate mofetil with cyclophosphamide have confirmed the efficacy of the former for induction and maintenance therapy--particularly induction therapy, owing to its favorable toxicity profile; however, claims of efficacy superior to that of cyclophosphamide require additional documentation. Nonetheless, an increasing number of physicians use mycophenolate mofetil as induction therapy for most cases of proliferative lupus nephritis, while reserving cyclophosphamide for the most severe cases. No evidence yet indicates that mycophenolate mofetil is better than azathioprine for the maintenance of remission. For patients who relapse or who are unable to be treated with these agents, rituximab seems to offer some benefit with an acceptable toxicity profile. This article summarizes the advances in the management of lupus nephritis since our 2005 Review.
机译：用于治疗狼疮性肾炎的新治疗手段（例如生物制剂）的引入，重新激发了对该疾病的研究，使研究者能够提出循证的建议。因此，现在已被广泛接受的是狼疮性肾炎的治疗涉及一段时间的强化诱导治疗，随后是较长时期的低强度维持治疗。基于组织学，人口统计学，临床和实验室特征的风险分层，可以确定处于肾功能不全风险高的患者，积极治疗可能是最有益的患者。新的研究和荟萃分析比较了麦考酚酸酯和环磷酰胺，证实了前者在诱导和维持疗法（特别是诱导疗法）方面的功效，因为其毒性良好。但是，要想获得优于环磷酰胺的功效，还需要其他文件。但是，越来越多的医生在大多数增生性狼疮性肾炎病例中使用麦考酚酸酯作为诱导疗法，而在大多数情况下保留环磷酰胺。尚无证据表明霉酚酸酯在维持缓解方面优于硫唑嘌呤。对于复发患者或无法用这些药物治疗的患者，利妥昔单抗似乎具有可接受的毒性特征，从而提供了某些益处。本文总结了自2005年回顾以来狼疮性肾炎的治疗进展。

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