Resumo

GONZALEZ NARANJO, Luis Alonso; VASQUEZ DUQUE, Gloria María; URIBE URIBE, Oscar  e  RAMIREZ GOMEZ, Luis Alberto. Lupus nephritis. Clinical presentation, classification and treatment. Rev.Colomb.Reumatol. [online]. 2006, vol.13, n.4, pp.307-333. ISSN 0121-8123.

Lupus nephritis (LN) is a major cause of morbility and mortality in patients with systemic lupus erythematosus (SLE). Similarly, kidney involvement is common in SLE, occurring in up to 60% of affected adults during the course of their disease. Recently, the classification of glomerulonephritis in SLE has been modified; in this classification, it was proposed that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving < 50% of total number of glomeruli) with subdivisions for active and sclerotic lesions; class IV for diffuse glomerulonephritis (involving = 50% of total number of glomeruli) either with segmental (class IV-S) or global (class IV-G) involvement, and also with subdivions for active and sclerotic lesions; class V for membranous glomerulonephritis; and class VI for advanced sclerotic lesions. It is important that combinations of membranous and proliferative glomerulonephritis should be reported individually in the diagnosis line, as well as the diagnosis should also include notations for any concomitant vascular or tubolointersticial lesions, therefore, one of the main advantages of this classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and giving a basis for further clinicopathologic studies. Otherwise, despite the development of new modalities of treatment in LN, cyclophosphamide remains the preferred initial treatment for severe forms of LN like proliferative and membranous glomerulonephritis associated with both, lesions of class III or class IV; nevertheless, the optimal treatment remains challenging because of the adverse effects associated with cyclophosphamide like sustained amenorrhea, infertility, increased susceptibility to infection, bone marrow suppression, hemorrhagic cystitis, and malignancy. Finally, due to these adverse effects new alternative approaches to the treatment of LN are desirable and also for some patients who fail to achieve remission with standar cytotoxic therapy and for who relapse when therapy is reduced. For refractory disease, new immunosuppressive and immunomodulating agents, immunoablative high dose of cyclophosphamide, apheresis and the biological response modifiers can be consider.

Palavras-chave : lupus nephropathy; systemic lupus erythematosus; treatment.

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