OP0064

JOINT EULAR/ERA-EDTA RECOMMENDATIONS FOR THE MANAGEMENT OF ADULT AND PEDIATRIC LUPUS NEPHRITIS

G. Bertsias ^1,*M. Tektonidou ²Z. Amoura ³M. Aringer ⁴I. Bajema ⁵J. Berden ⁶J. Boletis ⁷R. Cervera ⁸T. Dörner ⁹A. Doria ¹⁰F. Ferrario ¹¹J. Flöge ¹²F. Houssiau ¹³J. P. Ioannidis ¹⁴D. Isenberg ¹⁵C. G. Kallenberg ¹⁶L. Lightstone ¹⁷S. Marks ¹⁸A. Martini ¹⁹G. Moroni ²⁰I. Neumann ²¹P. Niaudet ²²M. Praga ²³M. Schneider ²⁴V. Tesar ²⁵C. Vasconcelos ²⁶R. van Vollenhoven ²⁷E. Zakharova ²⁸M. Haubitz ²⁹C. Gordon ³⁰D. Jayne ³¹D. Boumpas ¹

¹University Of Crete, Heraklion, ²Rheumatology, University of Athens, Athens, Greece, ³Hôpital Pitié-Salpêtrière, Paris, France, ⁴Universitätsklinikum Carl Gustav Carus, Dresden, Germany, ⁵Leiden University Medical Center, Leiden, ⁶NCMLS, Nijmegen, Netherlands, ⁷Laiko Hospital, Athens, Greece, ⁸Universitat de Barcelona, Barcelona, Spain, ⁹Charité - Universitätsmedizin Berlin , Berlin , Germany, ¹⁰University of Padova, Padova, ¹¹San Carlo Borromeo Hospital and Fondazione , Milan, Italy, ¹²University Hospital, Aachen, Germany, ¹³Université catholique de Louvain, Brussels, Belgium, ¹⁴Stanford University School of Medicine, Stanford, United States, ¹⁵University College Hospital, London, United Kingdom, ¹⁶University Hospital Groningen, Groningen, Netherlands, ¹⁷Imperial College London, ¹⁸University College London Institute of Child Health, London, United Kingdom, ¹⁹University of Genoa , Genoa , ²⁰Fondazione Ospedale Maggiore Policlinco, Milan, Italy, ²¹Fachärztin für Innere Medizin, Wien, Austria, ²²Hopital Necker Enfants Malades Tour Lavoisier, Paris, France, ²³Hospital 12 de Octubre, Madrid, Spain, ²⁴Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany, ²⁵Charles University, Praque, Czech Republic, ²⁶Centro Hospitalar do Porto, Porto, Portugal, ²⁷Karolinska Institute, Stockholm, Sweden, ²⁸University of Moscow, Moscow, Russian Federation, ²⁹Medizinische Hochschule , Hannover, Germany, ³⁰University of Birmingham , ³¹Cambridge University, London, United Kingdom

Background: There is increasing evidence from clinical trials on which to base a rational approach to the care of lupus nephritis (LN).

Objectives: To develop recommendations for the management of LN.

Methods: Questions were compiled using a modified Delphi technique. A systematic PubMed search was performed, and evidence-based and expert-opinion approach was followed to prepare recommendations.

Results: No clinical, serologic or laboratory tests can accurately predict renal biopsy findings in SLE; any sign of renal involvement, especially proteinuria >0.5 g/24-hr, should be an indication for biopsy. Assessment should include glomerular changes, activity and chronicity indices, tubulointerstitial lesions, and vascular lesions. Because of more favourable efficacy/toxicity ratio, for most patients with ISN/RPS2003 Class III_A or _A/C and Class IV_A or _A/C (±V) LN, mycophenolate mofetil (MMF) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. Induction regimens should be combined initially with three daily pulses of IV methylprednisolone, followed by oral prednisolone 0.5 mg/kg/day. In patients with adverse clinical or histological features, CY can also be prescribed monthly at higher doses (0.75-1g/m²) for 6 months or orally for 3 months. For pure class V disease with nephrotic-range proteinuria, MMF in combination with oral prednisolone may be used initially. In patients responding to initial therapy (≥50% reduction in proteinuria and stable/improved GFR) within 6-12 months, maintenance immunosuppression is recommended with MMF or azathioprine for at least 3 years. For MMF or CY failures, we recommend switching to the other or rituximab. Pregnancy should be planned in stable patients with inactive lupus and serum creatinine <2 mg/dL. The intensity of treatment should not be reduced in anticipation of pregnancy. Nephritis is more frequent at presentation in children with SLE and its diagnosis, management, and monitoring is similar to that in adults.

Conclusions: Recommendations for LN were developed using an evidence-based approach followed by expert consensus.

Disclosure of Interest: None Declared