acreular狼疮性肾炎指南解读总结.pptx

ACR 和 EULAR/ERA・EDTA 有关 LN 指南解读
内容
• ACR指南详细解读
• EULAR/ERA-EDTA 指南概述
•两个指南的异同点
:口
•展望
Arthritis Care & Res ea先前未治疗的患者均 应接受肾脏活检（除非有严格禁忌）。
口意义：
/可使用现有的ISN/RPS分类标准对肾脏疾病分类。
/可对疾病进行评估：慢性和活动性、肾小管和血管病变。
/可识别其它肾脏病原因如：药物、低血容量或低血压相关的 肾小管坏死。
/治疗在很大程度上基于ISN/RPS分类标准。
强烈推荐肾活检指标
Table 2. Indications for renal biopsy in patients with systemic lupus erythematosus*
Level of evidence
Increasing serum creatinine without compelling C alternative causes (such as sepsis, hypovolemia, or medication)
Confirmed proteinuria of > gm per 24 hours C (either 24-hour urine specimens or spot protein/creatinine ratios are acceptable)
Combinations of the following, assuming the C
findings are confirmed in at least 2 tests done within a short period of time and in the absence of alternative causes:
a. Proteinuria > gm per 24 hours plus hematuria, defined as >5 RBCs per hpf
b. Proteinuria > gm per 24 hours plus cellular casts
* RBCs = red blood cells; hpf = high-power field.
肾脏病理分型
Table 1. International Society of Nephrology/Renal Pathology Society 2003 classification of LN*
Class 1 Minimal mesangial LN
Class II Mesangial proliferative LN
Class 111 Focal LN (<50% of glomeruli)
111 (A): active lesions
III (A/C): active and chronic lesions
III (C): chronic lesions
Class IV Diffuse LN (>50% glomeruli)
Diffuse segmental (1V-S) or global (IV-G) LN
IV (A): active lesions
IV (A/C): active and chronic lesions
IV (C): chronic lesions
Class V Membranous LN十
Class VI Advanced sclerosing LN (>90% globally sclerosed glomeruli without residual activity)
* Adapted, with permission, from ref. 15. LN = lupus nephritis, t Class V may occur in combination with class III or IV, in which case both will be diagnosed.
特殊的病理改变与预后
•新月体形成
-与肾脏不良预后密切相关
•血管病变
-合并血栓性微血管病预后最差
•肾间质病变
-间质炎症、小管萎缩、间质纤维化与不良预后 相关
•足细胞病变
-1型LN合并足细胞病变，给予CNIs治疗
辅助用药
□ HCQ应作为所有LN患者基础治疗药物，除非有禁忌
复发率降低。
可显著减少肾脏损害
可减少SLE患者血栓事件发生率。
□ LN蛋白尿〉0. 5g/24h或尿蛋白/肌酎＞,应予 ACEI或ARB治疗
可降低球内压，减少尿蛋白约30%
优于CCB和利尿剂单独治疗
但孕妇禁用
辅助用药
/合并