kdigo、美国风湿病学会、欧洲风湿联盟狼疮治疗推荐课件

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1、KDIGO、美国风湿病学会、欧洲风湿联盟狼疮治疗推荐DepartmentofNephrology,2ndAffiliatedHospitalofGuangzhouUniversityofChineseMedicine,Guangzhou,PRChinaKDIGO狼疮肾炎指南3KDIGO狼疮肾炎指南3KDIGO狼疮肾炎指南3KDIGO狼疮肾炎指南3KDIGO狼疮肾炎指南3LN的复发建议在获得完全或部分缓解的LN复发应使用初始治疗有效的诱导及维持方案（2B）如果重新开始初始方案会有导致CTX过量的风险，建议使用一个无CT

2、X的初始治疗方案(2B)复发时如果怀疑LN组织学类型发生改变或者无法判断血清肌酐增高和/或蛋白尿加重是病情活动还是慢性的，应考虑重复肾活检(未分级)KDIGO狼疮肾炎指南33美国狼疮肾炎指南TheTaskForcePanelrecommendedthatallSLEpatientswithnephritisbetreatedwithabackgroundofhydroxychloroquine(HCQ;levelCevidence),unlessthereisacontraindication.推荐羟氯喹作为LN患者

3、的基础治疗(C级证据)，除非有禁忌症3美国狼疮肾炎指南III.AdjunctiveTreatmentsAllLNpatientswithproteinuria0.5gmper24hours(orequivalentbyrotein/creatinineratiosonspoturinesamples)shouldhaveblockadeoftherenin–angiotensinsystem,whichdrivesintraglomerularpressure(levelAevidencefornondiabetic

4、chronicrenaldisease).Treatmentwitheitherangiotensin-convertingenzyme(ACE)inhibitorsorangiotensinreceptorblockers(ARBs)reducesproteinuriabyapproximately30%,andsignificantlydelaysdoublingofserumcreatinineandprogressiontoend-stagerenaldiseaseinpatientswithnondiabe

5、ticchronicrenaldisease(22).Theseclassesofmedicationsarecontraindicatedinpregnancy.TheuseofcombinationACEinhibitors/ARBtherapiesiscontroversial(23).ACEinhibitorsorARBtreatmentsaresuperiortocalcium-channelblockersanddiureticsaloneinpreservingrenalfunctioninchroni

6、ckidneydisease(24).（蛋白尿大于0.5g的LN患者，推荐加用ACEI/ARB治疗，A级证据，是通过减低球内压起作用，能够减少30%的蛋白尿，延缓肌酐翻倍和发展至终末期肾病）而对于ACEI联合ARB方面，尚存在争论。3美国狼疮肾炎指南TheTaskForcePanelrecommendedthatcarefulattentionbepaidtocontrolofhypertension,withatargetof130/80mmHg(levelAevidencefornondiabeticchron

7、icrenaldisease).Therecommendationisbasedonprospectivetrialsandmeta-analysesshowingthatobservingthistargetisassociatedwithasignificantdelayinprogressionofrenaldisease,comparedtohighertargetsorinadequatebloodpressurecontrol(22).TheTaskForcePanelalsorecommendedtha

8、tstatintherapybeintroducedinpatientswithlow-densitylipoproteincholesterol100mg/dl(levelCevidence)(25).Notethataglomerularfiltrationrate60ml/minute/1.73m2(equivalenttoaseru