Materiały źródłowe

• #1 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Lupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE) a chronic autoimmune disease that causes inflammation and damage to multiple organ systems, with the kidneys as a primary target. […] Early detection of SLE through monitoring renal function, including serum creatinine levels, urine protein-to-creatinine ratios, and urinalysis, is essential for effectively managing the condition. […] The primary treatment goal is to preserve kidney function, slow disease progression, and improve outcomes, with therapies tailored to the specific pathological lesion. […] Treatment may include hydroxychloroquine for all patients and immunosuppressive or steroid therapy for more severe forms. […] This activity emphasizes the importance of interprofessional collaboration among healthcare providers in managing lupus nephritis and delivering integrated care.

• #2 Lupus Nephritis: What Is It, Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/21809-lupus-nephritis

  Lupus nephritis is kidney inflammation due to lupus, an autoimmune disease. […] About half of adults and 80% of children with lupus will develop lupus nephritis. […] Lupus nephritis prevents your kidneys from controlling blood pressure and blood volume. […] It can lead to a variety of serious health problems, including kidney failure and end-stage renal disease. […] Medication and diet changes are the most common treatments for lupus nephritis. […] Your healthcare provider may recommend blood pressure medication, corticosteroids and immunosuppressive drugs, diet changes, and diuretics. […] Kidney failure develops in 10% to 30% of people with lupus nephritis. […] If this happens, you may need dialysis or a kidney transplant. […] It’s important to seek treatment for lupus nephritis right away. Managing the condition with medication and diet changes may help delay or prevent kidney failure. People with severe lupus nephritis may need dialysis or a kidney transplant.

• #3 Lupus and kidney disease (lupus nephritis) – Symptoms, treatment, & stages | National Kidney Foundation

  https://www.kidney.org/kidney-topics/lupus-nephritis

  Lupus nephritis (LN) is an inflammation of the kidneys caused by systemic lupus erythematosus, often called lupus. When you have LN, your kidneys are not doing a good job removing waste from your blood or controlling the amount of fluids in your body. […] Most medications for LN work to prevent the overactive immune system from attacking the kidneys. Other medicines are used to keep your kidneys healthy. Treatments differ depending on the class of the disease. […] The goals of treatment for lupus nephritis are to: Reduce inflammation in your kidneys, Decrease immune system activity, Block your body’s immune cells from attacking the kidneys directly or making antibodies that attack the kidneys. […] Depending on your class/type of LN, your nephrologist will likely recommend a treatment plan that is right for you and will help keep your kidneys working well. These treatments can range from simple monitoring (watching and testing) to stronger medicines that help manage any symptoms and prevent more harm to your kidneys.

• #4 7 Systemic Lupus Erythematosus Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/systemic-lupus-erythematosus-nursing-care-plans/

  Nursing goals of a client will systemic lupus erythematosus (SLE) may include relief of pain and discomfort, relief of fatigue, maintenance of skin integrity, compliance with the prescribed medications, increased knowledge regarding the disease, and absence of complications. […] The following are the nursing priorities for patients with systemic lupus erythematosus (SLE): Perform assessments to identify signs and symptoms of systemic lupus erythematosus (SLE). Administer prescribed medications, such as corticosteroids or immunosuppressants, to manage disease activity. Monitor and document disease progression, including organ involvement and complications. Educate patients on the importance of medication adherence and potential side effects. Provide support and guidance for managing symptoms and minimizing disease triggers.

• #5 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), a chronic inflammatory and autoimmune disease that leads to tissue and organ damage. […] Early diagnosis and initiation of effective treatment may help to promote preservation of kidney function and reduce health care costs. […] The goals of LN management are to prevent progression to CKD or ESRD and include patient survival, long-term preservation of kidney function, prevention of renal flares and organ damage, management of comorbidities, and improvement of disease-related quality of life. […] Improvement or preservation of kidney function may be accompanied by a reduction in proteinuria. […] Treatment should aim for a complete clinical response, defined as a target UPCR of below 0.5 to 0.7 g/g at 12 months.

• #6 Lupus nephritis | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/kidney-conditions/lupus-nephritis/

  In lupus nephritis the bodys immune system attacks the kidney, particularly the filtering structures in the kidney called glomeruli (there are around a million of these in the kidneys), causing inflammation. […] The goal is to detect lupus nephritis before kidney function becomes that bad and prescribe drugs that can support kidney function by switching off the inflammation and preventing further damage, says Dr Jones. […] When you have lupus nephritis, it is usual to be treated by a nephrologist (a doctor who specialises in the kidneys). […] You may also be treated by your rheumatologist. […] There are a number of treatments available for lupus nephritis, which aim to preserve kidney function, prevent disease flare ups, and improve quality of life and survival. […] Having an autoimmune disease such as lupus can raise the risk of cardiovascular disease. Fatigue and depression are common complaints with lupus, so maintaining a healthy lifestyle is important, says Dr Jones.

• #7 Lupus nephritis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lupus-nephritis/symptoms-causes/syc-20354335

  Lupus nephritis is a problem that occurs often in people who have systemic lupus erythematosus, also called lupus. […] Lupus nephritis occurs when lupus autoantibodies affect parts of the kidneys that filter out waste. This causes swelling and irritation of the kidneys, called inflammation. It might lead to blood in the urine, protein in the urine, high blood pressure, kidneys that don’t work well or even kidney failure. […] As many as half of adults with systemic lupus get lupus nephritis. Systemic lupus causes the body’s immune system to damage the kidneys. Then the kidneys can’t filter out waste as they should. […] Lupus nephritis can cause hypertension. […] Lupus nephritis care at Mayo Clinic.

• #8 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Renal biopsy is fundamental to accurately diagnosing lupus nephritis. […] The treatment of lupus nephritis is primarily guided by histopathological class. […] All patients should initiate therapy with hydroxychloroquine at baseline unless contraindicated, with regular ophthalmological exams to assess for retinal toxicity. […] Treating risk factors that may contribute to the progression of CKD or ESRD is crucial for patients with lupus nephritis. […] The treatment of lupus nephritis involves induction and maintenance phases, utilizing both immunosuppressive and non-immunosuppressive therapies. […] Patients with ESRD due to lupus nephritis who initiate dialysis experience outcomes similar to those of dialysis patients without lupus nephritis. […] Healthcare providers should educate patients on the signs and symptoms of lupus nephritis and regularly monitor their renal function. […] Effectively caring for these patients requires a collaborative approach among healthcare professionals, ensuring patient-centered care and improving overall outcomes.

• #9 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  Lupus nephritis affects over half of all patients with systemic lupus erythematosus (SLE). This condition increases mortality and morbidity rates among patients due to, among other reasons, the risk of chronic kidney disease with the need for renal replacement therapy in approximately 25% of cases. […] Lupus nephritis should be classified according to the histological classes defined in 2003 by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS). […] A renal biopsy is mandatory in patients with SLE and tests results indicative of renal involvement, such as increased creatinine, reduced glomerular filtration rate, proteinuria, haematuria, and active urinary sediments. […] Patients with lupus nephritis should be tested for normal clinical and laboratory parameters in chronic patients, specifying the variables involved in the development of cardiovascular complications.

• #10 Lupus nephritis | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/kidney-conditions/lupus-nephritis/

  Many people with lupus nephritis have no specific symptoms until it is more severe. Damage to the kidneys will show on urine tests much earlier than in blood tests, so you should have regular urine tests as part of routine lupus check-ups so that it can be diagnosed and monitored as early as possible. Treating any kidney involvement early can help to prevent further damage, or the damage becoming more severe. […] Specialist lupus nurses are available to give advice at some hospitals on practical issues such as medication side effects.

• #11 Lupus nephritis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lupus-nephritis/symptoms-causes/syc-20354335

  Lupus nephritis is a problem that occurs often in people who have systemic lupus erythematosus, also called lupus. […] Lupus nephritis occurs when lupus autoantibodies affect parts of the kidneys that filter out waste. This causes swelling and irritation of the kidneys, called inflammation. It might lead to blood in the urine, protein in the urine, high blood pressure, kidneys that don’t work well or even kidney failure. […] As many as half of adults with systemic lupus get lupus nephritis. Systemic lupus causes the body’s immune system to damage the kidneys. Then the kidneys can’t filter out waste as they should. […] Lupus nephritis can cause hypertension. […] Lupus nephritis care at Mayo Clinic.

• #12 Lupus Nephritis: Diagnosis, Symptoms, Treatments

  https://www.webmd.com/lupus/lupus-nephritis

  Lupus nephritis is inflammation of the kidney that is caused by systemic lupus erythematosus (SLE). […] Up to 60% of lupus patients will develop lupus nephritis. […] When the kidneys are inflamed, they can’t function normally and can leak protein. If not controlled, lupus nephritis can lead to kidney failure. […] The diagnosis of lupus nephritis begins with a medical history, physical exam, and evaluation of symptoms. Your doctor will likely order tests to make or confirm a diagnosis. […] There are five types of lupus nephritis. Treatment is based on the type of lupus nephritis, which is determined by the biopsy. […] Medications used in treatment can include corticosteroids. […] Doctors generally taper down the dosage once the symptoms start to improve. […] Even with treatment, loss of kidney function sometimes progresses. If both kidneys fail, people with lupus nephritis may need dialysis.

• #13 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Recommendations from the European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) state that kidney biopsy should be considered in patients with SLE who exhibit signs of kidney involvement, including glomerular hematuria and/or cellular casts, proteinuria exceeding 0.5 g per 24 hours (or spot UPCR 0.5 g/g), and unexplained decrease in GFR. […] The kidney biopsy is indispensable as a diagnostic and prognostic tool for identifying the nature and extent of renal involvement and tissue damage, and earlier use of biopsy may be associated with improved outcomes, regardless of histologic severity. […] Regular monitoring for response to treatment involves assessments similar to those used for surveillance and diagnosis of LN; additionally, repeated kidney biopsy may be warranted in patients whose disease is nonresponsive or relapsing to gather prognostic information and to identify other pathologies. […] In patients whose disease progresses to ESRD, all methods of kidney replacement treatments are recommended, although transplantation is associated with higher survival rates and, therefore, may be preferred.

• #14 Advances in the care of children with lupus nephritis | Pediatric Research

  https://www.nature.com/articles/pr2016247

  The care of children with lupus nephritis (LN) has changed dramatically over the past 50 y. […] In children, LN tends to present earlier and behaves more aggressively. […] By reviewing the numerous studies published by pediatric researchers on the management of LN in cSLE, we highlight the advancements over the past 50 y. […] Kidney biopsy remains the gold standard for diagnosis of LN in cSLE. […] The ISN/RPS classification improved the precision of class definitions and distinguished between active and chronic lesions, although inter-pathologist variation and reproducibility remain suboptimal. […] Practice patterns for initial and repeat kidney biopsy have been published for cSLE. […] Therapeutic goals for the treatment of LN include: achieving prompt renal remission, avoiding renal flares, preventing chronic renal impairment, and minimizing iatrogenic effects.

• #15 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Recommendations from the European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) state that kidney biopsy should be considered in patients with SLE who exhibit signs of kidney involvement, including glomerular hematuria and/or cellular casts, proteinuria exceeding 0.5 g per 24 hours (or spot UPCR 0.5 g/g), and unexplained decrease in GFR. […] The kidney biopsy is indispensable as a diagnostic and prognostic tool for identifying the nature and extent of renal involvement and tissue damage, and earlier use of biopsy may be associated with improved outcomes, regardless of histologic severity. […] Regular monitoring for response to treatment involves assessments similar to those used for surveillance and diagnosis of LN; additionally, repeated kidney biopsy may be warranted in patients whose disease is nonresponsive or relapsing to gather prognostic information and to identify other pathologies. […] In patients whose disease progresses to ESRD, all methods of kidney replacement treatments are recommended, although transplantation is associated with higher survival rates and, therefore, may be preferred.

• #16 Lupus nephritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lupus-nephritis/diagnosis-treatment/drc-20446438

  Our caring team of Mayo Clinic experts can help you with your lupus nephritis-related health concerns […] There’s no cure for lupus nephritis. Treatment aims to: […] Keep kidneys working well enough to not need a machine to filter waste from blood, called dialysis, or a kidney transplant. […] In general, these treatments might help people with kidney disease: […] Medicines to treat lupus nephritis might include: […] Ongoing clinical trials are testing new treatments for lupus nephritis. […] For people who progress to kidney failure, treatment options include: […] Dialysis helps remove fluid and waste from the body, maintain the right balance of minerals in the blood, and manage blood pressure by filtering the blood through a machine. […] If kidneys stop working, a kidney from a donor, called a transplant, might be needed. […] Lupus nephritis care at Mayo Clinic.

• #17 FloridaHealthFinder | Lupus nephritis | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/000481

  Lupus nephritis, which is a kidney disorder, is a complication of systemic lupus erythematosus. […] The goal of treatment is to improve kidney function and to delay kidney failure. […] Medicines may include drugs that suppress the immune system, such as corticosteroids, cyclophosphamide, mycophenolate mofetil, or azathioprine. […] You may need dialysis to control symptoms of kidney failure, sometimes for only a while. A kidney transplant may be recommended. People with active lupus should not have a transplant because the condition can occur in the transplanted kidney. […] Contact your provider if you have blood in your urine or swelling of your body. […] If you have lupus nephritis, contact your provider if you notice decreased urine output. […] Treating lupus may help prevent or delay onset of lupus nephritis.

• #18 Lupus Nephritis Program: Lupus & APS Center of Excellence

  https://www.hss.edu/lupus-center-of-excellence-lupus-nephritis-program.asp

  The goal of the therapy is to fully control inflammation (Induction Therapy) or to achieve at least major improvement in parameters of kidney function (e.g., reduce the amounts of protein lost in the urine, promote improvement in blood level of creatinine) with minimization of symptoms. […] Once good control of the disease is achieved, Maintenance Therapy is used to prevent further flares.

• #19 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  We recommend that patients treated with corticosteroids receive oral supplements of calcium and vitamin D, as long as no contraindications exist. […] We recommend not exceeding a cumulative dose of 10g cyclophosphamide in order to minimise the risk of ovarian toxicity. […] We recommend carrying out all vaccination protocols based on age and to avoid vaccines containing live or attenuated viruses during immunosuppression. […] The treatment of the most severe histological classes of lupus nephritis (classes III and IV) and class V is divided into two phases. […] In patients with class III or IV lupus nephritis, we recommend treating with glucocorticosteroids accompanied by one of the following therapeutic options: Cyclophosphamide, Mycophenolate mofetil, or enteric-coated mycophenolate sodium.

• #20 Lupus Nephritis Treatment & Management: Approach Considerations, Pharmacotherapy for Lupus Nephritis Based on Stage, New Therapies

  https://emedicine.medscape.com/article/330369-treatment

  The principal goal of therapy in lupus nephritis is to normalize kidney function or, at least, to prevent the progressive loss of kidney function. Therapy differs depending on the pathologic lesion. It is important to treat extrarenal manifestations and other variables that may affect the kidneys. Patients should be on hydroxychloroquine if possible, as data suggest that this improves outcomes in patients who have lupus nephritis, in addition to reducing lupus-related flares and disease damage accrual. […] Corticosteroid therapy should be instituted if the patient has clinically significant renal disease. Use immunosuppressive agents, particularly cyclophosphamide, azathioprine, or mycophenolate mofetil, if the patient has aggressive proliferative renal lesions, as they improve the renal outcome. Immunosuppressives can also be used if the patient has an inadequate response or excessive sensitivity to corticosteroids.

• #21 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Lupus nephritis is one of the more common and severe manifestations of systemic lupus erythematosus (SLE). This article covers the causes, risk factors, symptoms, diagnosis, and treatment of lupus nephritis. […] The primary goal of lupus nephritis treatment is to avoid chronic kidney disease. The treatment regimen selected should be based on the ISN/RPS classification criteria. […] Hydroxychloroquine is recommended for all patients with lupus nephritis unless a contraindication exists, according to guidelines from KDIGO and the American College of Rheumatology (ACR). […] Additionally, all patients with proteinuria 0.5 g per 24 hours should be prescribed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to block the renin-angiotensin system. […] The most common adverse reactions are nausea/vomiting, diarrhea, and abdominal pain.

• #22 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Lupus nephritis is one of the more common and severe manifestations of systemic lupus erythematosus (SLE). This article covers the causes, risk factors, symptoms, diagnosis, and treatment of lupus nephritis. […] The primary goal of lupus nephritis treatment is to avoid chronic kidney disease. The treatment regimen selected should be based on the ISN/RPS classification criteria. […] Hydroxychloroquine is recommended for all patients with lupus nephritis unless a contraindication exists, according to guidelines from KDIGO and the American College of Rheumatology (ACR). […] Additionally, all patients with proteinuria 0.5 g per 24 hours should be prescribed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to block the renin-angiotensin system. […] The most common adverse reactions are nausea/vomiting, diarrhea, and abdominal pain.

• #23 Lupus Nephritis Treatment Consensus and Future Directions – Renal and Urology News

  https://www.renalandurologynews.com/news/lupus-nephritis-treatment-consensus-and-future-directions/

  Lupus nephritis (LN) develops in as many as two-thirds of patients with systemic lupus erythematosus (SLE) within 5 years of SLE onset. Once LN occurs, it is associated with worse morbidity, health-related quality of life, and mortality. Kidney failure is a major concern. […] Hydroxychloroquine is universally recommended for initial therapy but requires dosage adjustment in patients with low estimated glomerular filtration rate (eGFR). […] Guidelines from major rheumatology and nephrology associations agree that conventional induction therapies for severe LN include high doses of glucocorticoids with either cyclophosphamide or mycophenolate mofetil (MMF). […] Tacrolimus, a calcineurin inhibitor, is recommended as second-line therapy for LN in Asian patients who cannot tolerate cyclophosphamide or MMF.

• #24 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Regular retinal and cardiac exams are recommended for all patients taking hydroxychloroquine. […] Glucocorticoids are anti-inflammatory drugs that include the following: Betamethasone; Dexamethasone; Methylprednisolone; and Prednisone. […] Pulsed intravenous (IV) glucocorticoids are recommended for initial treatment of Class III or Class IV lupus nephritis. […] According to the KDIGO guidelines, glucocorticoids may be discontinued after a patient has maintained a complete clinical renal response for at least 12 months. […] Cyclophosphamide is an immunosuppressant that may be used as initial therapy for Class III/IV lupus nephritis in patients who may have difficulty adhering to an oral therapy. […] Belimumab is a human monoclonal antibody that acts as a B-lymphocyte stimulator (BLyS)-specific inhibitor.

• #25 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Regular retinal and cardiac exams are recommended for all patients taking hydroxychloroquine. […] Glucocorticoids are anti-inflammatory drugs that include the following: Betamethasone; Dexamethasone; Methylprednisolone; and Prednisone. […] Pulsed intravenous (IV) glucocorticoids are recommended for initial treatment of Class III or Class IV lupus nephritis. […] According to the KDIGO guidelines, glucocorticoids may be discontinued after a patient has maintained a complete clinical renal response for at least 12 months. […] Cyclophosphamide is an immunosuppressant that may be used as initial therapy for Class III/IV lupus nephritis in patients who may have difficulty adhering to an oral therapy. […] Belimumab is a human monoclonal antibody that acts as a B-lymphocyte stimulator (BLyS)-specific inhibitor.

• #26 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Regular retinal and cardiac exams are recommended for all patients taking hydroxychloroquine. […] Glucocorticoids are anti-inflammatory drugs that include the following: Betamethasone; Dexamethasone; Methylprednisolone; and Prednisone. […] Pulsed intravenous (IV) glucocorticoids are recommended for initial treatment of Class III or Class IV lupus nephritis. […] According to the KDIGO guidelines, glucocorticoids may be discontinued after a patient has maintained a complete clinical renal response for at least 12 months. […] Cyclophosphamide is an immunosuppressant that may be used as initial therapy for Class III/IV lupus nephritis in patients who may have difficulty adhering to an oral therapy. […] Belimumab is a human monoclonal antibody that acts as a B-lymphocyte stimulator (BLyS)-specific inhibitor.

• #27

  https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2017/09000/managing_lupus_nephritis.10.aspx

  GENERAL PURPOSE: To provide an overview of lupus nephritis and review nursing considerations for its management. […] LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 2. Identify treatment objectives and nursing considerations. […] Treatment for lupus nephritis depends on the degree of inflammation. […] Treatment for lupus nephritis depends on the class as determined by renal biopsy. […] Treatment for lupus nephritis depends on the level of proteinuria. […] Pulse corticosteroid therapy reduces inflammation of acute flares. […] Pulse corticosteroid therapy permits long-term steroid administration without physical sequelae. […] Which immunosuppressive agent causes the most suppression in white blood cell counts? […] Which drug is used to reduce hypercoagulability in patients with antiphospholipid antibodies?

• #28 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Regular retinal and cardiac exams are recommended for all patients taking hydroxychloroquine. […] Glucocorticoids are anti-inflammatory drugs that include the following: Betamethasone; Dexamethasone; Methylprednisolone; and Prednisone. […] Pulsed intravenous (IV) glucocorticoids are recommended for initial treatment of Class III or Class IV lupus nephritis. […] According to the KDIGO guidelines, glucocorticoids may be discontinued after a patient has maintained a complete clinical renal response for at least 12 months. […] Cyclophosphamide is an immunosuppressant that may be used as initial therapy for Class III/IV lupus nephritis in patients who may have difficulty adhering to an oral therapy. […] Belimumab is a human monoclonal antibody that acts as a B-lymphocyte stimulator (BLyS)-specific inhibitor.

• #29 Lupus Nephritis Treatment & Management: Approach Considerations, Pharmacotherapy for Lupus Nephritis Based on Stage, New Therapies

  https://emedicine.medscape.com/article/330369-treatment

  The principal goal of therapy in lupus nephritis is to normalize kidney function or, at least, to prevent the progressive loss of kidney function. Therapy differs depending on the pathologic lesion. It is important to treat extrarenal manifestations and other variables that may affect the kidneys. Patients should be on hydroxychloroquine if possible, as data suggest that this improves outcomes in patients who have lupus nephritis, in addition to reducing lupus-related flares and disease damage accrual. […] Corticosteroid therapy should be instituted if the patient has clinically significant renal disease. Use immunosuppressive agents, particularly cyclophosphamide, azathioprine, or mycophenolate mofetil, if the patient has aggressive proliferative renal lesions, as they improve the renal outcome. Immunosuppressives can also be used if the patient has an inadequate response or excessive sensitivity to corticosteroids.

• #30 FloridaHealthFinder | Lupus nephritis | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/000481

  Lupus nephritis, which is a kidney disorder, is a complication of systemic lupus erythematosus. […] The goal of treatment is to improve kidney function and to delay kidney failure. […] Medicines may include drugs that suppress the immune system, such as corticosteroids, cyclophosphamide, mycophenolate mofetil, or azathioprine. […] You may need dialysis to control symptoms of kidney failure, sometimes for only a while. A kidney transplant may be recommended. People with active lupus should not have a transplant because the condition can occur in the transplanted kidney. […] Contact your provider if you have blood in your urine or swelling of your body. […] If you have lupus nephritis, contact your provider if you notice decreased urine output. […] Treating lupus may help prevent or delay onset of lupus nephritis.

• #31 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Calcineurin inhibitors (CNIs) help to block T cell activation and decrease the inflammatory response. […] According to the KDIGO guidelines, a CNI-containing regimen may be preferred for some patients, including those who have preserved kidney function; proteinuria caused by podocyte injury; contraindications to cyclophosphamide-based regimens; or who can’t tolerate standard-dose MPAA. […] Guidelines for diagnosing and treating lupus nephritis include the following: The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the management of lupus nephritis.

• #32 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Calcineurin inhibitors (CNIs) help to block T cell activation and decrease the inflammatory response. […] According to the KDIGO guidelines, a CNI-containing regimen may be preferred for some patients, including those who have preserved kidney function; proteinuria caused by podocyte injury; contraindications to cyclophosphamide-based regimens; or who can’t tolerate standard-dose MPAA. […] Guidelines for diagnosing and treating lupus nephritis include the following: The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the management of lupus nephritis.

• #33 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Regular retinal and cardiac exams are recommended for all patients taking hydroxychloroquine. […] Glucocorticoids are anti-inflammatory drugs that include the following: Betamethasone; Dexamethasone; Methylprednisolone; and Prednisone. […] Pulsed intravenous (IV) glucocorticoids are recommended for initial treatment of Class III or Class IV lupus nephritis. […] According to the KDIGO guidelines, glucocorticoids may be discontinued after a patient has maintained a complete clinical renal response for at least 12 months. […] Cyclophosphamide is an immunosuppressant that may be used as initial therapy for Class III/IV lupus nephritis in patients who may have difficulty adhering to an oral therapy. […] Belimumab is a human monoclonal antibody that acts as a B-lymphocyte stimulator (BLyS)-specific inhibitor.

• #34 First drugs ever approved for lupus nephritis | Ohio State Medical Center

  https://wexnermedical.osu.edu/departments/innovations/nephrology/lupus-nephritis-drugs

  RovinPhysicians have new treatment options for patients with lupus nephritis. […] Other than steroids, there had been no drugs approved specifically for lupus nephritisever, says Brad Rovin, MD, director of the Division of Nephrology and medical director of the Center for Clinical Research Management at the Ohio State Wexner Medical Center. […] Lupus nephritis occurs in patients who have systemic lupus erythematosus, an autoimmune disease. […] About 40% to 50% of patients with systemic lupus will develop lupus nephritis. […] In December 2020, belimumab (Benlysta), which was previously approved for the treatment of systemic lupus erythematosus, was approved for lupus nephritis. […] In January 2021, voclosporin (Lupkynis), a calcineurin inhibitor, was approved as the first oral drug for lupus nephritis.

• #35 Advances in the care of children with lupus nephritis | Pediatric Research

  https://www.nature.com/articles/pr2016247

  Fortunately, several steroid-sparing therapies have been implemented. […] A lower dose CYC protocol was initially used in Europe in adults (the Euro-lupus protocol) and holds promise for LN in children. […] Another less toxic approach to induction therapy has been mycophenolate mofetil (MMF), an inhibitor of the de novo purine synthesis pathway with selectivity for proliferating lymphocytes. […] Despite prospective clinical trials failing to show benefit for use of B-cell depleting agents in SLE, there are numerous observational studies reporting efficacy for refractory disease using rituximab as an add-on therapy for use in both adult- and cSLE. […] The development of CTPs in 2012 for induction therapy of newly diagnosed proliferative LN in cSLE represents a tremendous advancement.

• #36 II Brazilian Society of Rheumatology consensus for lupus nephritis diagnosis and treatment | Advances in Rheumatology | Full Text

  https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-024-00386-8

  Rituximab can be prescribed in cases of refractory disease. […] In cases of failure in achieving TRR, it is important to assess adherence, immunosuppressant dosage, adjuvant therapy, comorbidities, and consider biopsy/rebiopsy. […] This consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil.

• #37 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Lupus nephritis is one of the more common and severe manifestations of systemic lupus erythematosus (SLE). This article covers the causes, risk factors, symptoms, diagnosis, and treatment of lupus nephritis. […] The primary goal of lupus nephritis treatment is to avoid chronic kidney disease. The treatment regimen selected should be based on the ISN/RPS classification criteria. […] Hydroxychloroquine is recommended for all patients with lupus nephritis unless a contraindication exists, according to guidelines from KDIGO and the American College of Rheumatology (ACR). […] Additionally, all patients with proteinuria 0.5 g per 24 hours should be prescribed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to block the renin-angiotensin system. […] The most common adverse reactions are nausea/vomiting, diarrhea, and abdominal pain.

• #38 Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Nephrology (S.E.N.) | N

  https://revistanefrologia.com/en-diagnosis-treatment-lupus-nephritis-consensus-articulo-X2013251412000644

  Given the level of associated morbidity, the use of oral corticosteroids has been recommended only at the lowest doses and shortest time spans possible. […] We recommend that patients with SLE receive hydroxychloroquine on a long-term basis if no contraindications exist. […] We recommend that patients with lupus nephritis, proteinuria, and/or arterial hypertension receive renin-angiotensin-aldosterone system (RAAS) blockers. […] We recommend evaluating cardiovascular risk and implementing both pharmacological and non-pharmacological measures to decrease the probability of developing accelerated arteriosclerosis. […] We recommend the use of drugs for gastric protection in patients with a history of gastrointestinal haemorrhage or ulcerative disease and those under concomitant treatment with corticosteroids and non-steroidal anti-inflammatories.

• #39 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Lupus nephritis is one of the more common and severe manifestations of systemic lupus erythematosus (SLE). This article covers the causes, risk factors, symptoms, diagnosis, and treatment of lupus nephritis. […] The primary goal of lupus nephritis treatment is to avoid chronic kidney disease. The treatment regimen selected should be based on the ISN/RPS classification criteria. […] Hydroxychloroquine is recommended for all patients with lupus nephritis unless a contraindication exists, according to guidelines from KDIGO and the American College of Rheumatology (ACR). […] Additionally, all patients with proteinuria 0.5 g per 24 hours should be prescribed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to block the renin-angiotensin system. […] The most common adverse reactions are nausea/vomiting, diarrhea, and abdominal pain.

• #40 Lupus Nephritis: What Is It, Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/21809-lupus-nephritis

  Lupus nephritis is kidney inflammation due to lupus, an autoimmune disease. […] About half of adults and 80% of children with lupus will develop lupus nephritis. […] Lupus nephritis prevents your kidneys from controlling blood pressure and blood volume. […] It can lead to a variety of serious health problems, including kidney failure and end-stage renal disease. […] Medication and diet changes are the most common treatments for lupus nephritis. […] Your healthcare provider may recommend blood pressure medication, corticosteroids and immunosuppressive drugs, diet changes, and diuretics. […] Kidney failure develops in 10% to 30% of people with lupus nephritis. […] If this happens, you may need dialysis or a kidney transplant. […] It’s important to seek treatment for lupus nephritis right away. Managing the condition with medication and diet changes may help delay or prevent kidney failure. People with severe lupus nephritis may need dialysis or a kidney transplant.

• #41

  https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2017/09000/managing_lupus_nephritis.10.aspx

  GENERAL PURPOSE: To provide an overview of lupus nephritis and review nursing considerations for its management. […] LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 2. Identify treatment objectives and nursing considerations. […] Treatment for lupus nephritis depends on the degree of inflammation. […] Treatment for lupus nephritis depends on the class as determined by renal biopsy. […] Treatment for lupus nephritis depends on the level of proteinuria. […] Pulse corticosteroid therapy reduces inflammation of acute flares. […] Pulse corticosteroid therapy permits long-term steroid administration without physical sequelae. […] Which immunosuppressive agent causes the most suppression in white blood cell counts? […] Which drug is used to reduce hypercoagulability in patients with antiphospholipid antibodies?

• #42 First drugs ever approved for lupus nephritis | Ohio State Medical Center

  https://wexnermedical.osu.edu/departments/innovations/nephrology/lupus-nephritis-drugs

  RovinPhysicians have new treatment options for patients with lupus nephritis. […] Other than steroids, there had been no drugs approved specifically for lupus nephritisever, says Brad Rovin, MD, director of the Division of Nephrology and medical director of the Center for Clinical Research Management at the Ohio State Wexner Medical Center. […] Lupus nephritis occurs in patients who have systemic lupus erythematosus, an autoimmune disease. […] About 40% to 50% of patients with systemic lupus will develop lupus nephritis. […] In December 2020, belimumab (Benlysta), which was previously approved for the treatment of systemic lupus erythematosus, was approved for lupus nephritis. […] In January 2021, voclosporin (Lupkynis), a calcineurin inhibitor, was approved as the first oral drug for lupus nephritis.

• #43 First drugs ever approved for lupus nephritis | Ohio State Medical Center

  https://wexnermedical.osu.edu/departments/innovations/nephrology/lupus-nephritis-drugs

  Before the approval of belimumab and voclosporin, doctors relied on high-dose corticosteroids plus a broad-spectrum immunosuppressive agent to manage their patients lupus nephritis. […] One of the new medications for lupus nephritis, belimumab, is not a steroid; its a biologic therapy given by injection, in conjunction with a patients other lupus medications. […] The other new medication, voclosporin, is an oral therapy used in combination with background immunosuppression. […] During their respective clinical trials, researchers added belimumab or voclosporin to the patients’ background treatment. […] The goal of lupus nephritis treatment is to preserve kidney function and prevent or delay the need for dialysis or transplantation, and, Dr. Rovin says, these new medications improved kidney remissions at one or two years, which is critical for good long-term kidney outcomes.

• #44 Lupus nephritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lupus-nephritis/diagnosis-treatment/drc-20446438

  Our caring team of Mayo Clinic experts can help you with your lupus nephritis-related health concerns […] There’s no cure for lupus nephritis. Treatment aims to: […] Keep kidneys working well enough to not need a machine to filter waste from blood, called dialysis, or a kidney transplant. […] In general, these treatments might help people with kidney disease: […] Medicines to treat lupus nephritis might include: […] Ongoing clinical trials are testing new treatments for lupus nephritis. […] For people who progress to kidney failure, treatment options include: […] Dialysis helps remove fluid and waste from the body, maintain the right balance of minerals in the blood, and manage blood pressure by filtering the blood through a machine. […] If kidneys stop working, a kidney from a donor, called a transplant, might be needed. […] Lupus nephritis care at Mayo Clinic.

• #45 Lupus Nephritis Treatment With CAR T-Cell Therapy | Kyverna

  https://kyvernatx.com/patients/lupus-nephritis/

  Lupus nephritis (LN) is a severe kidney manifestation of Systemic Lupus Erythematosus (SLE) that affects up to 50% of these patients and is a major cause of morbidity and mortality. […] Treatment goals of LN include long-term preservation of kidney function accompanied by improvements in proteinuria, survival, and quality of life, as well as prevention of disease flares and management of comorbidities. […] Despite recent advancements in treatment for LN, complete response rate (CRR) is achieved by less than 50% of patients and many patients will require dialysis and kidney transplant as their disease progresses.

• #46 7 Systemic Lupus Erythematosus Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/systemic-lupus-erythematosus-nursing-care-plans/

  Nursing goals of a client will systemic lupus erythematosus (SLE) may include relief of pain and discomfort, relief of fatigue, maintenance of skin integrity, compliance with the prescribed medications, increased knowledge regarding the disease, and absence of complications. […] The following are the nursing priorities for patients with systemic lupus erythematosus (SLE): Perform assessments to identify signs and symptoms of systemic lupus erythematosus (SLE). Administer prescribed medications, such as corticosteroids or immunosuppressants, to manage disease activity. Monitor and document disease progression, including organ involvement and complications. Educate patients on the importance of medication adherence and potential side effects. Provide support and guidance for managing symptoms and minimizing disease triggers.

• #47 7 Systemic Lupus Erythematosus Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/systemic-lupus-erythematosus-nursing-care-plans/

  After thorough assessment, nursing diagnoses are formulated to address the challenges of systemic lupus erythematosus (SLE), guided by the nurses clinical judgment and understanding of the patients unique condition. […] Risk for Impaired Renal Function due to potential lupus nephritis, indicated by decreased urine output and elevated creatinine levels. […] Nursing interventions and nursing actions for patients with systemic lupus erythematosus (SLE) may include: Assess and monitor the patient for signs and symptoms of disease activity. […] Monitor patients renal function. SLE can affect the kidneys, leading to lupus nephritis or kidney damage. Regularly monitor the patients kidney function by assessing urine output, conducting urine analysis for proteinuria, and collaborating with the healthcare team to perform renal function tests (e.g., blood urea nitrogen, creatinine). […] Assess patients skin condition. Skin manifestations, such as rashes or photosensitivity, are common in SLE. Regularly assess the patients skin for any changes, including new rashes, lesions, or ulcerations.

• #48

  https://www.nursingcenter.com/cearticle?an=00152258-202309000-00002&Journal_ID=417221&Issue_ID=6747329

  1. Medication treatment is the standard intervention to manage inflammation in SLE. Medication classifications include corticosteroids (CS), disease-modifying antirheumatic drugs (DMARDs), and biological response modifiers (BRMs). […] 2. Selected nursing interventions include conducting a head-to-toe physical assessment, correlating physical assessment findings with lab indicators of inflammation, monitoring medication responses, encouraging anti-inflammatory nutrition, and promoting health strategies to improve quality of life. […] 3. Conduct a head-to-toe physical assessment. Mood changes may be related to fatigue, medications, and depression from chronic illness. Changes in cognition, speech, and motor movement may indicate inflammation of the central nervous system. Assess joints for redness, swelling, pain, and limitation in range of motion. Erythema, rashes, and mucosal lesions may indicate inflammation in the body’s vital organs. Assess respiratory rate, depth, rhythm, and oxygen saturation. Auscultate the lungs for pleural friction rubs and crackles. Assess cardiac rate and rhythm. Auscultate the heart valves for murmurs from valvular dysfunction and pericardial friction rubs. Assess the abdomen for bowel sounds, pain, or distension. Assess for infections, pain level, and quality of life.

• #49 7 Systemic Lupus Erythematosus Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/systemic-lupus-erythematosus-nursing-care-plans/

  After thorough assessment, nursing diagnoses are formulated to address the challenges of systemic lupus erythematosus (SLE), guided by the nurses clinical judgment and understanding of the patients unique condition. […] Risk for Impaired Renal Function due to potential lupus nephritis, indicated by decreased urine output and elevated creatinine levels. […] Nursing interventions and nursing actions for patients with systemic lupus erythematosus (SLE) may include: Assess and monitor the patient for signs and symptoms of disease activity. […] Monitor patients renal function. SLE can affect the kidneys, leading to lupus nephritis or kidney damage. Regularly monitor the patients kidney function by assessing urine output, conducting urine analysis for proteinuria, and collaborating with the healthcare team to perform renal function tests (e.g., blood urea nitrogen, creatinine). […] Assess patients skin condition. Skin manifestations, such as rashes or photosensitivity, are common in SLE. Regularly assess the patients skin for any changes, including new rashes, lesions, or ulcerations.

• #50 7 Systemic Lupus Erythematosus Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/systemic-lupus-erythematosus-nursing-care-plans/

  Nursing goals of a client will systemic lupus erythematosus (SLE) may include relief of pain and discomfort, relief of fatigue, maintenance of skin integrity, compliance with the prescribed medications, increased knowledge regarding the disease, and absence of complications. […] The following are the nursing priorities for patients with systemic lupus erythematosus (SLE): Perform assessments to identify signs and symptoms of systemic lupus erythematosus (SLE). Administer prescribed medications, such as corticosteroids or immunosuppressants, to manage disease activity. Monitor and document disease progression, including organ involvement and complications. Educate patients on the importance of medication adherence and potential side effects. Provide support and guidance for managing symptoms and minimizing disease triggers.

• #51

  https://www.nursingcenter.com/cearticle?an=00152258-202309000-00002&Journal_ID=417221&Issue_ID=6747329

  4. Correlate any physical assessment findings with lab indicators of inflammation. For example, elevated C-reactive protein and erythrocyte sedimentation rate and low RBCs, C3, and C4. Imaging studies also indicate inflammation. For example, ultrasound and MRI show inflammation and damage to joints and soft tissues without synovitis and bone erosion. […] 5. Systemic medications control inflammation. The efficacy of these medications is measured with improved symptoms and minimal to no adverse reactions. Nurses should teach patients to report adverse reactions to medications, including but not limited to an increase in pain or discomfort, the onset of fever (infection and increased inflammation), bleeding from anywhere in the body, weight gain or loss, changes in mental status, abdominal pain or discomfort, and skin rashes and lesions.

• #52 Nursing Care Plan For Systemic Lupus Erythematosus (SLE) – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-systemic-lupus-erythematosus-sle/

  Lupus is characterized by periods of flare-ups and remission, making its management complex and requiring personalized care plans. […] The nursing care plan for systemic lupus erythematosus aims to provide evidence-based interventions to support patients during flare-ups, implement measures to prevent complications and promote overall patient well-being during remission. […] Education is a key component of the nursing care plan, as patients need to understand the nature of lupus, the importance of adherence to medications, lifestyle modifications, and the significance of regular follow-up appointments to manage the disease effectively. […] Risk for Impaired Renal Function related to potential kidney involvement and lupus nephritis. […] By implementing these nursing interventions, healthcare providers can effectively manage systemic lupus erythematosus, promote patient well-being, and support individuals in achieving better outcomes and improved quality of life.

• #53 Nursing Care Plan For Systemic Lupus Erythematosus (SLE) – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-systemic-lupus-erythematosus-sle/

  Education is a crucial component of the nursing care plan, empowering patients to actively participate in their care, adhere to medication regimens, and adopt lifestyle modifications to manage systemic lupus erythematosus effectively. […] By continually evaluating and updating the care plan to meet the changing needs of the patient, nurses can support individuals living with systemic lupus erythematosus on their journey toward optimal health and well-being.

• #54 7 Systemic Lupus Erythematosus Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/systemic-lupus-erythematosus-nursing-care-plans/

  Nursing goals of a client will systemic lupus erythematosus (SLE) may include relief of pain and discomfort, relief of fatigue, maintenance of skin integrity, compliance with the prescribed medications, increased knowledge regarding the disease, and absence of complications. […] The following are the nursing priorities for patients with systemic lupus erythematosus (SLE): Perform assessments to identify signs and symptoms of systemic lupus erythematosus (SLE). Administer prescribed medications, such as corticosteroids or immunosuppressants, to manage disease activity. Monitor and document disease progression, including organ involvement and complications. Educate patients on the importance of medication adherence and potential side effects. Provide support and guidance for managing symptoms and minimizing disease triggers.

• #55 Lupus Nephritis Treatment & Management: Approach Considerations, Pharmacotherapy for Lupus Nephritis Based on Stage, New Therapies

  https://emedicine.medscape.com/article/330369-treatment

  Calcineurin inhibitors, especially tacrolimus, have demonstrated benefit in lupus nephritis. However, most studies have been limited to Asian patients, and further research is required on long-term benefits and disadvantages. […] Treat hypertension aggressively. On the basis of beneficial effects in other nephropathies, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been routinely used to treat proteinuria in lupus nephritis. […] Alter the diet according to the presence of hypertension, hyperlipidemia, and renal insufficiency. Restrict fat intake or use lipid-lowering therapy such as statins for hyperlipidemia secondary to nephrotic syndrome. Restrict protein intake if renal function is significantly impaired. […] Administer calcium supplementation to prevent osteoporosis if the patient is on long-term corticosteroid therapy, and consider adding a bisphosphonate (depending on renal function).

• #56 Lupus nephritis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/lupus-nephritis

  In general, these treatments might help people with kidney disease: […] Limiting the amount of protein and salt in the diet can help the kidneys work better. […] Medicines to treat lupus nephritis might include: […] For people who progress to kidney failure, treatment options include: […] Dialysis helps remove fluid and waste from the body, maintain the right balance of minerals in the blood, and manage blood pressure by filtering the blood through a machine. […] If kidneys stop working, a kidney from a donor, called a transplant, might be needed.

• #57

  https://www.nursingcenter.com/cearticle?an=00152258-202309000-00002&Journal_ID=417221&Issue_ID=6747329

  6. Foods with anti-inflammatory properties should be encouraged, including fish, vegetables, fruit, beans, legumes, seeds, whole grain bread, oats, olive oil, and tofu. Overweight and obesity proinflammatory cytokines that can worsen SLE. Patients should consult a dietitian to help them with healthy food choices. […] 7. Patients with SLE may have challenges coping with chronic illness and comorbidities unrelated to SLE. Strategies to promote quality of life include adhering to the treatment plan, receiving vaccinations as indicated, avoiding people who are sick, wearing an N95 or KN95 mask if receiving immunosuppressive medications, sun protection such as wide-brimmed hats, wearing sunglasses, and applying sun protection factor greater than or equal to 30, wearing comfortable clothing, getting plenty of sleep, resting at intervals, being physically active, getting a hobby, avoiding smoking and excessive alcohol consumption, and engaging in support groups. […] 8. The primary goals in managing SLE are controlling inflammation to protect body organs and tissues from damage, reducing pain and discomfort, and promoting quality of life.

• #58 Lupus nephritis – Symptoms, treatment and complications – American Kidney Fund (AKF)

  https://www.kidneyfund.org/all-about-kidneys/other-kidney-diseases/lupus-nephritis-symptoms-treatment-and-complications

  Lupus nephritis can cause permanent kidney damage, which is called chronic kidney disease, or CKD. […] The treatment for lupus nephritis focuses on preventing more damage to your kidneys. Finding and treating lupus nephritis early can help prevent serious damage. […] Your health care provider might want you to take a medicine called an immunosuppressant. These types of medicines weaken your immune system so that it cannot harm your kidneys as much. […] It is important that everyone on your treatment team has up-to-date information about your health. […] If you have not been diagnosed, trying to figure out the cause of your symptoms can be challenging too. […] If you want to talk to a professional, ask a member of your treatment team for a referral to a mental health therapist, counselor or social worker. […] Having a chronic disease like lupus nephritis can feel isolating. But you are not alone. […] Benefits of joining a support group include: Being able to talk openly and honestly with people who understand what you are going through.

• #59 Nursing Care Plan For Systemic Lupus Erythematosus (SLE) – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-systemic-lupus-erythematosus-sle/

  Lupus is characterized by periods of flare-ups and remission, making its management complex and requiring personalized care plans. […] The nursing care plan for systemic lupus erythematosus aims to provide evidence-based interventions to support patients during flare-ups, implement measures to prevent complications and promote overall patient well-being during remission. […] Education is a key component of the nursing care plan, as patients need to understand the nature of lupus, the importance of adherence to medications, lifestyle modifications, and the significance of regular follow-up appointments to manage the disease effectively. […] Risk for Impaired Renal Function related to potential kidney involvement and lupus nephritis. […] By implementing these nursing interventions, healthcare providers can effectively manage systemic lupus erythematosus, promote patient well-being, and support individuals in achieving better outcomes and improved quality of life.

• #60

  https://www.nursingcenter.com/cearticle?an=00152258-202309000-00002&Journal_ID=417221&Issue_ID=6747329

  6. Foods with anti-inflammatory properties should be encouraged, including fish, vegetables, fruit, beans, legumes, seeds, whole grain bread, oats, olive oil, and tofu. Overweight and obesity proinflammatory cytokines that can worsen SLE. Patients should consult a dietitian to help them with healthy food choices. […] 7. Patients with SLE may have challenges coping with chronic illness and comorbidities unrelated to SLE. Strategies to promote quality of life include adhering to the treatment plan, receiving vaccinations as indicated, avoiding people who are sick, wearing an N95 or KN95 mask if receiving immunosuppressive medications, sun protection such as wide-brimmed hats, wearing sunglasses, and applying sun protection factor greater than or equal to 30, wearing comfortable clothing, getting plenty of sleep, resting at intervals, being physically active, getting a hobby, avoiding smoking and excessive alcohol consumption, and engaging in support groups. […] 8. The primary goals in managing SLE are controlling inflammation to protect body organs and tissues from damage, reducing pain and discomfort, and promoting quality of life.

• #61 For optimal lupus nephritis care, bring rheumatologists and nephrologists together

  https://www.nature.com/articles/d42473-021-00319-9

  Lupus puts the body at war with itself. […] More than 1.5 million people develop one of the most dangerous manifestations of SLE: lupus nephritis (LN), characterized by immune system induced inflammation of the kidneys. […] Early and effective treatment, and the prevention of flares, represent the most important targets for SLE patients with kidney involvement, says Marta Mosca, a rheumatologist at the University of Pisa in Italy. […] Chronic use of corticosteroids, particularly at higher daily doses, can raise patients risk of irreversible organ damage, says Liz Lightstone, a professor of renal medicine at Imperial College London, and an expert in LN. […] Mosca was part of an international team that updated European guidelines, issued by European Alliance of Associations for Rheumatology (EULAR) in 2019, and which advocated minimizing the use of steroids.

• #62 Advances in the care of children with lupus nephritis | Pediatric Research

  https://www.nature.com/articles/pr2016247

  Managing chronic illness is time consuming and complicated. […] Comprehensive care of a pediatric patient with SLE requires a multidisciplinary team including: pediatric rheumatology, nephrology, ophthalmology, psychology, the primary care physician and/or adolescent medicine, and sometimes physical therapy, dermatology, cardiology, orthopedics, neurology, gastroenterology, pulmonary, or infectious disease. […] The goal for the immediate future will be to identify the causes for these health disparities and to begin to address them. […] Overall, graft survival and infection-related complications are comparable between transplantation patients with LN-associated ESKD and allograft recipients with ESKD because of other causes. […] There remains a great need for more research in children with LN to develop a more precise classification system of kidney injury based on more intricate molecular details of cellular function and inflammation.

• #63 Lupus Nephritis Program: Lupus & APS Center of Excellence

  https://www.hss.edu/lupus-center-of-excellence-lupus-nephritis-program.asp

  Lupus nephritis experts from Hospital for Special Surgery, NewYork-Presbyterian Hospital, and Weill Cornell Medicine work together to provide world-class care for lupus patients with nephritis. […] Our goal at the Lupus and APS Center of Excellence is to provide the best possible care for our lupus nephritis patients by using the exceptional resources available to us at Hospital for Special Surgery, NewYork-Presbyterian Hospital, and Weill Cornell Medicine. […] Our approach to treating lupus nephritis is multidisciplinary and includes close collaboration of our rheumatologists, nephrologists, kidney pathologist, nurse practitioner, and infusion room nurses. […] Prompt diagnosis of lupus nephritis and proper classification of the disease allows for selection of the best therapeutic options for each case.

• #64 Learn About the New Treatment Guidelines for Lupus Nephritis | Lupus Foundation of America

  https://www.lupus.org/blog/learn-about-the-new-treatment-guidelines-for-lupus-nephritis

  Guideline recommendations are not rules for treating any one specific patient. Rather, they are meant to offer advice to healthcare providers about different ways to treat patients with lupus nephritis. […] When you have a diagnosis of lupus, its important to be aware of the new clinical guidelines for lupus nephritis so that you can ask your healthcare provider about important screenings. […] Its important to remember that you are not alone if you are diagnosed with lupus nephritis. Many different health care providers, like internal medicine doctors, rheumatologists, nephrologists, and their teams of nurse practitioners, physician assistants, nurses, and pharmacists can assist with shared decision-making and finding the right treatment plan for you.

• #65 Survey Shows Education and Communication Gaps in Lupus Nephritis Care | National Kidney Foundation

  https://www.kidney.org/press-room/survey-shows-education-and-communication-gaps-lupus-nephritis-care

  Significant gaps in education and communication among patients and physicians pose barriers to lupus nephritis (LN) care, according to results of two companion surveys conducted by the National Kidney Foundation (NKF) and the Lupus Research Alliance (LRA). […] Recognizing their need for more knowledge about LN, over three quarters of patients want information about treatment options, importance of treatment, risk factors for LN and how to reduce them, need for tests and whats involved as well as a basic understanding of LN. […] The results also strongly suggest the need for more of a multidisciplinary approach to treatment with coordination among rheumatologists, nephrologists and primary care physicians. […] These results confirm the need for both healthcare provider and public education, which the two organizations are addressing with a free continuing medical education course for healthcare professionals about ways to better diagnose and improve outcomes for patients with systemic lupus erythematosus (SLE) and lupus nephritis.

• #66 Survey Shows Education and Communication Gaps in Lupus Nephritis Care | National Kidney Foundation

  https://www.kidney.org/press-room/survey-shows-education-and-communication-gaps-lupus-nephritis-care

  Significant gaps in education and communication among patients and physicians pose barriers to lupus nephritis (LN) care, according to results of two companion surveys conducted by the National Kidney Foundation (NKF) and the Lupus Research Alliance (LRA). […] Recognizing their need for more knowledge about LN, over three quarters of patients want information about treatment options, importance of treatment, risk factors for LN and how to reduce them, need for tests and whats involved as well as a basic understanding of LN. […] The results also strongly suggest the need for more of a multidisciplinary approach to treatment with coordination among rheumatologists, nephrologists and primary care physicians. […] These results confirm the need for both healthcare provider and public education, which the two organizations are addressing with a free continuing medical education course for healthcare professionals about ways to better diagnose and improve outcomes for patients with systemic lupus erythematosus (SLE) and lupus nephritis.

• #67 New Survey Shows Education and Communication Gaps in Lupus Nephritis Care – Lupus Research Alliance

  https://www.lupusresearch.org/new-survey-shows-education-and-communication-gaps-in-lupus-nephritis-care-2/

  1 in 2 Lupus Nephritis Patients Dont Know They Have Lupus […] Significant gaps in education and communication among patients and physicians pose barriers to lupus nephritis (LN) care, according to results of two companion surveys conducted by the National Kidney Foundation (NKF) and the Lupus Research Alliance (LRA). […] Recognizing their need for more knowledge about LN, over three quarters of patients want information about treatment options, importance of treatment, risk factors for LN and how to reduce them, need for tests and whats involved as well as a basic understanding of LN. […] Healthcare professionals agree; 79 percent say not enough patient education on LN is a barrier to successful treatment at least some of the time. […] The results also strongly suggest the need for more of a multidisciplinary approach to treatment with coordination among rheumatologists, nephrologists and primary care physicians.

• #68 New Survey Shows Education and Communication Gaps in Lupus Nephritis Care – Lupus Research Alliance

  https://www.lupusresearch.org/new-survey-shows-education-and-communication-gaps-in-lupus-nephritis-care-2/

  While rheumatologists are more likely than nephrologists to support a collaborative team approach to managing LN, less than one third of them and five percent of nephrologists report this level of coordination in their practice. […] The two groups differ on who should lead LN management; 39 percent of nephrologists say their specialty should handle LN compared with 45 percent of rheumatologists say they should be leading care. […] These data suggest that greater education and awareness are critically needed to improve care, particularly as new therapies for lupus nephritis, now being reviewed by the U.S. Food Drug Administration, become available. […] Results from the survey also point to a need for a greater communication among all healthcare professionals caring for patients with lupus and lupus nephritis, particularly primary care, rheumatology and nephrology. […] Future initiatives are needed to address this critical need to promote a multidisciplinary treatment approach that manages the many complications of lupus as it can damage virtually any organ or tissue.

• #69 Lupus Nephritis: What Is It, Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/21809-lupus-nephritis

  Lupus nephritis is kidney inflammation due to lupus, an autoimmune disease. […] About half of adults and 80% of children with lupus will develop lupus nephritis. […] Lupus nephritis prevents your kidneys from controlling blood pressure and blood volume. […] It can lead to a variety of serious health problems, including kidney failure and end-stage renal disease. […] Medication and diet changes are the most common treatments for lupus nephritis. […] Your healthcare provider may recommend blood pressure medication, corticosteroids and immunosuppressive drugs, diet changes, and diuretics. […] Kidney failure develops in 10% to 30% of people with lupus nephritis. […] If this happens, you may need dialysis or a kidney transplant. […] It’s important to seek treatment for lupus nephritis right away. Managing the condition with medication and diet changes may help delay or prevent kidney failure. People with severe lupus nephritis may need dialysis or a kidney transplant.

• #70 Lupus Nephritis: Diagnosis, Symptoms, Treatments

  https://www.webmd.com/lupus/lupus-nephritis

  Lupus nephritis is inflammation of the kidney that is caused by systemic lupus erythematosus (SLE). […] Up to 60% of lupus patients will develop lupus nephritis. […] When the kidneys are inflamed, they can’t function normally and can leak protein. If not controlled, lupus nephritis can lead to kidney failure. […] The diagnosis of lupus nephritis begins with a medical history, physical exam, and evaluation of symptoms. Your doctor will likely order tests to make or confirm a diagnosis. […] There are five types of lupus nephritis. Treatment is based on the type of lupus nephritis, which is determined by the biopsy. […] Medications used in treatment can include corticosteroids. […] Doctors generally taper down the dosage once the symptoms start to improve. […] Even with treatment, loss of kidney function sometimes progresses. If both kidneys fail, people with lupus nephritis may need dialysis.

• #71 Lupus Nephritis: What Is It, Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/21809-lupus-nephritis

  Lupus nephritis is kidney inflammation due to lupus, an autoimmune disease. […] About half of adults and 80% of children with lupus will develop lupus nephritis. […] Lupus nephritis prevents your kidneys from controlling blood pressure and blood volume. […] It can lead to a variety of serious health problems, including kidney failure and end-stage renal disease. […] Medication and diet changes are the most common treatments for lupus nephritis. […] Your healthcare provider may recommend blood pressure medication, corticosteroids and immunosuppressive drugs, diet changes, and diuretics. […] Kidney failure develops in 10% to 30% of people with lupus nephritis. […] If this happens, you may need dialysis or a kidney transplant. […] It’s important to seek treatment for lupus nephritis right away. Managing the condition with medication and diet changes may help delay or prevent kidney failure. People with severe lupus nephritis may need dialysis or a kidney transplant.

• #72 Lupus Nephritis: Diagnosis, Symptoms, Treatments

  https://www.webmd.com/lupus/lupus-nephritis

  Ultimately, it may be necessary to have a kidney transplant. […] Certain lifestyle habits can help protect the kidneys. People with lupus nephritis should do the following: Drink enough fluids to stay well hydrated. […] Although lupus nephritis is a serious problem, most people who receive treatment do not go on to have kidney failure. […] The most serious complication of lupus nephritis is permanent damage to your kidneys. […] Currently, around 20% of people with lupus nephritis eventually lose kidney function. […] For certain ethnic groups, lupus is more likely to lead to complications like lupus nephritis. […] Blacks, Hispanics, and APIs had more kidney damage than whites. […] Scientists aren’t yet sure what accounts for these differences, but they continue to study the subject.

• #73 Lupus nephritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lupus-nephritis/diagnosis-treatment/drc-20446438

  Our caring team of Mayo Clinic experts can help you with your lupus nephritis-related health concerns […] There’s no cure for lupus nephritis. Treatment aims to: […] Keep kidneys working well enough to not need a machine to filter waste from blood, called dialysis, or a kidney transplant. […] In general, these treatments might help people with kidney disease: […] Medicines to treat lupus nephritis might include: […] Ongoing clinical trials are testing new treatments for lupus nephritis. […] For people who progress to kidney failure, treatment options include: […] Dialysis helps remove fluid and waste from the body, maintain the right balance of minerals in the blood, and manage blood pressure by filtering the blood through a machine. […] If kidneys stop working, a kidney from a donor, called a transplant, might be needed. […] Lupus nephritis care at Mayo Clinic.

• #74 Lupus nephritis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/lupus-nephritis

  In general, these treatments might help people with kidney disease: […] Limiting the amount of protein and salt in the diet can help the kidneys work better. […] Medicines to treat lupus nephritis might include: […] For people who progress to kidney failure, treatment options include: […] Dialysis helps remove fluid and waste from the body, maintain the right balance of minerals in the blood, and manage blood pressure by filtering the blood through a machine. […] If kidneys stop working, a kidney from a donor, called a transplant, might be needed.

• #75 Lupus Nephritis | Nephrology Associates of Upland and Pomona

  https://www.nephrologyassociatesonline.com/lupus-nephritis.php

  Lupus nephritis is typically treated by managing its symptoms through medication and diet. Treatment focuses on reducing inflammation and treating the underlying cause of lupus. Some patients may require treatment to restore normal kidney function, and reduce the risk of permanent damage. Treatment includes the following: […] In some cases, dialysis may be needed temporarily to provide adequate kidney function. Severe cases may require a kidney transplant. […] Avoiding medications that can affect the kidneys also helps in lowering the risk of lupus nephritis.

• #76 Lupus Nephritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499817/

  Renal biopsy is fundamental to accurately diagnosing lupus nephritis. […] The treatment of lupus nephritis is primarily guided by histopathological class. […] All patients should initiate therapy with hydroxychloroquine at baseline unless contraindicated, with regular ophthalmological exams to assess for retinal toxicity. […] Treating risk factors that may contribute to the progression of CKD or ESRD is crucial for patients with lupus nephritis. […] The treatment of lupus nephritis involves induction and maintenance phases, utilizing both immunosuppressive and non-immunosuppressive therapies. […] Patients with ESRD due to lupus nephritis who initiate dialysis experience outcomes similar to those of dialysis patients without lupus nephritis. […] Healthcare providers should educate patients on the signs and symptoms of lupus nephritis and regularly monitor their renal function. […] Effectively caring for these patients requires a collaborative approach among healthcare professionals, ensuring patient-centered care and improving overall outcomes.

• #77 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), a chronic inflammatory and autoimmune disease that leads to tissue and organ damage. […] Early diagnosis and initiation of effective treatment may help to promote preservation of kidney function and reduce health care costs. […] The goals of LN management are to prevent progression to CKD or ESRD and include patient survival, long-term preservation of kidney function, prevention of renal flares and organ damage, management of comorbidities, and improvement of disease-related quality of life. […] Improvement or preservation of kidney function may be accompanied by a reduction in proteinuria. […] Treatment should aim for a complete clinical response, defined as a target UPCR of below 0.5 to 0.7 g/g at 12 months.

• #78 7 Systemic Lupus Erythematosus Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/systemic-lupus-erythematosus-nursing-care-plans/

  Nursing goals of a client will systemic lupus erythematosus (SLE) may include relief of pain and discomfort, relief of fatigue, maintenance of skin integrity, compliance with the prescribed medications, increased knowledge regarding the disease, and absence of complications. […] The following are the nursing priorities for patients with systemic lupus erythematosus (SLE): Perform assessments to identify signs and symptoms of systemic lupus erythematosus (SLE). Administer prescribed medications, such as corticosteroids or immunosuppressants, to manage disease activity. Monitor and document disease progression, including organ involvement and complications. Educate patients on the importance of medication adherence and potential side effects. Provide support and guidance for managing symptoms and minimizing disease triggers.

• #79 Managing lupus nephritis: A guide for nurse practitioners – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30134437/

  Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus, an autoimmune disease that results in multiple organ injuries. […] This article highlights recommendations for the management of lupus erythematosus to improve quality of life. […] In addition, it provides NPs with evidence-based guidelines for managing patients with LN for positive health outcomes. […] Lupus Nephritis / nursing* Actions.

• #80 Management of Lupus Nephritis

  https://www.mdpi.com/2077-0383/10/4/670

  While it is true that this approach has ensured an overall survival of 80% at 5 years, the rate of complete renal response (CRR) at 6–12 months is only 20–40%, and up to 5–20% of patients will progress, often late, to ESKD, while an additional percentage will develop CKD. […] We suggest that the outcome of LN could be improved by the adoption of a treat-to-target approach and by switching from sequential to combination therapy. […] The treat-to-target approach is a very fashionable concept in inflammatory and auto-immune diseases. […] We suggest to adopt a treat-to-target approach for LN to limit nephron loss and thereby prevent CKD. Per protocol kidney biopsies performed after one year of treatment might be part of this strategy, which will be tested in REBIOLUP. The current SOC does not meet patient’s and physician’s expectations. A combination therapy, instead of a sequential therapy, might become the new paradigm, based on recent trials.

• #81 Lupus Nephritis Risk Factors and Biomarkers: An Update

  https://www.mdpi.com/1422-0067/24/19/14526

  Lupus nephritis (LN) represents the most severe organ manifestation of systemic lupus erythematosus (SLE) in terms of morbidity and mortality. […] To reduce these risks, tremendous efforts have been made in the last decade to characterize the different steps of the disease and to develop biomarkers in order to better (i) unravel the pre-SLE stage (e.g., anti-nuclear antibodies and interferon signature); (ii) more timely initiation of therapy by improving early and accurate LN diagnosis (e.g., pathologic classification was revised); (iii) monitor disease activity and therapeutic response (e.g., recommendation to re-biopsy, new urinary biomarkers); (iv) prevent disease flares (e.g., serologic and urinary biomarkers); (v) mitigate the deterioration in the renal function; and (vi) reduce side effects with new therapeutic guidelines and novel therapies. […] Consequently, an individualized treat-to-target strategy is mandatory, and for that, there is an unmet need to develop a set of accurate biomarkers to be used as the standard of care and adapted to each stage of the disease.

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