Title (croatian) LIJEČENJE LUPUSNOG NEFRITISA Title (english) TREATMENT OF LUPUS NEPHRITIS Author Srđan Novak Author's institution University of Rijeka Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract (croatian) U oko 50% bolesnika sa sistemskim eritemskim lupusom razvije se lupusni nefritis. Znakovi zahvaćenosti bubrega kao što su proteinurija ³0,5 g/24 h, osobito uz glomerularnu hematuriju i/ili cilindre u sedimentu indikacija su za biopsiju. Cilj imunosupresivne terapije u lupusnom nefritisu jest remisija uz nastojanje da se izbjegnu oštećenja uzrokovana lijekovima. Inicijalni lijekovi u LN-u razreda III (±V) i IV (±V) jesu intravenski ciklofosfamid (ukupna doza 3 g tijekom 3 mjeseca) ili mikofenolat mofetil (ili mikofenolična kiselina) u ciljnoj dozi od 3 g/dan tijekom 6 mjeseci, uvijek u kombinaciji s glukokortikoidima, dok se u membranskom nefritisu preporučuje mikofenolat mofetil u kombinaciji s glukokortikoidima. U bolesnika u kojih se prati poboljšanje nakon inicijalnog liječenja preporučuje se ili nastaviti s mikofenolat mofetilom u nižoj dozi (2 g/dan) ili uvesti azatioprin (2 mg/kg/dan), oba u kombinaciji s niskim dozama glukokortikoida najmanje tijekom 3 godine. U rezistentnim ili relapsirajućim oblicima lupusnog nefritisa preporučuje se zamijenti ciklofosfamid mikofenolat mofetilom, ili obrnuto, ili primijeniti rituksimab.
Abstract (english) Approximately 50% of patients with systemic lupus erythematosus will develop lupus nephritis. Signs of renal involvement such as proteinuria ³0.5 g/24 h especially with glomerular hematuria and/or cellular casts should be an indication for biopsy. Goals of immunosuppressive treatment in lupus nephritis is remission with avoidance of treatment-related harms. Initial treatment for patients with class III (±V) and class IV (±V) LN are intravenous cyclophosphamide (total dose 3 g over 3 months) or mycophenolate mofetil (or mycophenolic acid) in target dose of 3 g/day for 6 months, always in combination with glucocorticoids, wihile in class V, mycophenolate mofetil in combination with glucocorticoids is recommended. In patients improving after initial treatment, mycophenolate mofetil at lower doses (2 g/day) or azatioprine (2 mg/kg/day), both in combination with low dose prednisone for at least 3 years are recommended. In resistant and relapse cases switch from cyclophosphamide to mycophenolate mofetil, or vice versa, or rituximab is recommended.
Keywords (croatian)
Lupusni nefritis – klasifikacija, dijagnoza, farmakoterapija
Bubreg – patologija
Imunosupresivni lijekovi – terapijska primjena, način uporabe i doziranje
Ciklofosfamid – terapijska primjena, način uporabe i doziranje
Mikofenolna kiselina – analozi i derivati, terapijska primjena, način uporabe i doziranje
Glukokortikoidi – terapijska primjena, način uporabe i doziranje
Kimerna monoklonska protutijela – terapijska primjena, način uporabe i doziranje
Keywords (english)
Lupus nephritis – classification, diagnosis, drug therapy
Kidney – pathology
Immunosuppressive agents – therapeutic use, administration and dosage
Cyclophosphamide – therapeutic use, administration and dosage
Mycophenolic acid – analogs and derivatives, therapeutic use, administration and dosage
Glucocorticoids – therapeutic use, administration and dosage
Antibodies, monoclonal, murine-derived – therapeutic use, administration and dosage
Language croatian Publication type Professional paper - Review paper Publication status Published Peer review Peer review Publication version Published version Journal title Liječnički vjesnik Numbering vol. 136, no. 7-8, pp. 215-219 p-ISSN 0024-3477 e-ISSN 1849-2177 URN:NBN urn:nbn:hr:184:473272 Publication 2014-08-27 Document URL https://hrcak.srce.hr/172619 Type of resource Text Access conditions Open access Terms of use Created on 2018-05-18 15:28:05
