Joined
·
36 Posts
http://www.kidney.org.uk/Medical-Info/kidney-disease/lupus-types.htmlType 3. "Focal proliferative nephritis". In this type of glomerulonephritis, the membrane in the kidney filter is thickened, and the cells supporting the filters are inflamed and overgrown. However this change affects only part of each kidney filter, and indeed many filters may not be affected at all.
This type of kidney disease in Lupus is intermediate in severity. Some people do require treatment with steroids and more powerful immunosuppressants, other people can have more gentle drug treatment. A long period of follow up in clinic is required, as there is a risk of this disease becoming active in the future, when more powerful treatment may be required. Many people with focal proliferative nephritis have good kidney function for many years, but there is a risk of kidney failure. There may be water retention in the body due to nephrotic syndrome
http://www.emedicine.com/med/topic1597.htmClasses III and IV: Patients with either focal or diffuse lupus nephritis are at high risk of progressing to end-stage renal disease and require aggressive therapy.
- Administer prednisone 1 mg/kg/d for at least 4 weeks, depending on clinical response. Then, taper it gradually to a daily maintenance dose of 5-10 mg/d for approximately 2 years. In acutely ill patients, intravenous methylprednisolone of up to 1000 mg/d for 3 days may be used to initiate corticosteroid therapy.
- Use immunosuppressive drugs in addition to corticosteroids in patients who do not respond to corticosteroids alone, who have unacceptable toxicity to corticosteroids, who have worsening renal function, who have severe proliferative lesions, or who have evidence of sclerosis on renal biopsy specimens. Both cyclophosphamide and azathioprine are effective for proliferative lupus nephritis, although cyclophosphamide is apparently more effective in preventing progression to end-stage renal disease. Mycophenolate mofetil has been shown to be effective in treating these patients and may be used alone or sequentially after a 6-month course of intravenous cyclophosphamide.
- Administer intravenous cyclophosphamide monthly for 6 months and every 2-3 months thereafter, depending on clinical response. The usual duration of therapy is 2-2.5 years. Reduce the dose if the creatinine clearance is less than 30 mL/min. Adjust the dose depending on the hematologic response. Gonadotropin-releasing hormone analog, leuprolide acetate, protects against ovarian failure.
- Azathioprine can also be used as a second-line agent, with dose adjustments depending on hematologic response.
- Mycophenolate mofetil is useful in patients with focal or diffuse lupus nephritis and has been shown to be at least as effective as intravenous cyclophosphamide with less toxicity in patients with stable renal function.
http://www.lupus.org/webmodules/webarticlesnet/templates/new_aboutaffects.aspx?a=100&z=17&page=3IIIVery early stage of more advanced lupus nephritis;
Focal Proliferative Nephritis
typically treated with high doses of corticosteroids, with excellent outcome.