J Rheum Dis.  2013 Jun;20(3):156-165. 10.4078/jrd.2013.20.3.156.

Diagnosis and Treatment of Lupus Nephritis: Survey Results on Four Important Issues

• Joo YB
• Sung YK
• Park YB
• Suh CH
• Shim SC
• Lee YH
• Lee J
• Lee HS
• Cha HS
• Bae SC

• KMID: 2222754
• DOI: http://doi.org/10.4078/jrd.2013.20.3.156

Abstract

OBJECTIVES
To investigate the perception of and treatment pattern with regard to the four important issues in the management of lupus nephritis (LN), and to identify which parts of the LN treatment are difficult for physicians to carry out in clinical practice.
METHODS
Four steps were carried out: pre-survey, LN symposium, post-survey, and meeting after the symposium.The two surveys were conducted with the same contents regarding renal biopsy, induction and maintenance treatment for class III and IV LN, and treatment for class V LN. The results of the first survey and the changes in opinion reflected in the second survey were comparatively analyzed.
RESULTS
In the first survey, most of the respondent physicians replied that they would immediately conduct biopsy in the case of significant proteinuria. For the induction treatment of class III and IV LN, most of the respondent physicians selected high-dose cyclophosphamide. Mycophenolate mofetil and steroid combination therapy were selected for the maintenance treatment, and tacrolimus for the treatment of class V LN. There was a controversy in the drug selection, however, especially on the maintenance treatment of class III and IV LN and on the treatment of non-responsive class V LN.
CONCLUSION
Some discrepancies were found in the treatment of LN in the real world. Although no recommendation was made for Korean LN patients in this study, the study results will help physicians select the most reasonable treatment for Korean LN patients based on experts' experiences and objective evidence.

Keyword

Lupus nephritis; Treatment; Guideline

MeSH Terms

Biopsy
Cyclophosphamide
Surveys and Questionnaires
Humans
Lupus Nephritis
Mycophenolic Acid
Proteinuria
Tacrolimus
Cyclophosphamide
Mycophenolic Acid
Tacrolimus

Figure

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  Figure 1. The four steps carried out in the study. LN: lupus nephritis.

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  Figure 2. (A) First-survey results on the diagnostic performance of renal biopsy. A: Immediate conduct of renal biopsy. B: Renal biopsy when the steroid dose is decreased to 20 mg/day or lower. C: Immunosuppressant administration, but if no response, renal biopsy. D: Biopsy omitted. E: Others. (B) First-survey results on the induction therapy on LN. A: Oral administration of mycophenolatemofetil. B: Oral administration of tacrolimus. C: Intravenous cyclophosphamide administration (NIH protocol). D: Intravenous cyclophosphamide administration (Eurolupus protocol). E: Others. (C) First-survey results on the maintenance therapy on LN. A: Azathioprine. B: Azathioprine+ glucocorticoid. C: Cyclosporine. D: Cyclosporine+ glucocorticoid. E: Cyclophosphamide. F: Cyclophosphamide+ glucocorticoid. G: Mycophenolatemofetil. H: Mycophenolatemofetil+ glucocorticoid. I: Others. (D) First-survey results on the maintenance therapy on LN. A: Maintenance and observation of the current treatment. B: Cyclophosphamide IV administration. C: Oral administration of mycophenolatemofetil. D: Oral administration of tacrolimus. E: Others.

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  Figure 3. (A) Change of opinion on the diagnostic performance of renal biopsy. A: Immediate conduct of renal biopsy. B: Renal biopsy when the steroid dose is decreased to 20 mg/day or lower. C: Immunosuppressant administration, but if no response, renal biopsy. D: Biopsy omitted. E: Others. (B) Change of opinion on the induction therapy on LN. A: Oral administration of mycophenolatemofetil. B: Oral administration of tacrolimus. C: Intravenous cyclophosphamide administration (NIH protocol). D: Intravenous cyclophosphamide administration (Eurolupus protocol). E: Others. (C) Change of opinion on the maintenance therapy on LN. A: Azathioprine. B: Azathioprine+ glucocorticoid. C: Cyclosporine. D: Cyclosporine+ glucocorticoid. E: Cyclophosphamide. F: Cyclophosphamide+ glucocorticoid. G: Mycophenolatemofetil. H: Mycophenolatemofetil+ glucocorticoid. I: Others. (D) Change of opinion on the maintenance therapy on LN. A: Maintenance and observation of the current treatment. B: Cyclophosphamide IV administration. C: Oral administration of mycophenolatemofetil. D: Oral administration of tacrolimus. E: Others.

Reference

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