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Lupusnephritis

Lupus nephritis

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Hintergrund

Der systemische Lupus erythematodes (SLE) ist ein komplexes Krankheitsbild mit variabler klinischer Ausprägung je nach vorliegender Organbeteiligung. Eine prognostisch nach wie vor ungünstige Krankheitsmanifestation stellt die Lupusnephritis dar. SLE-Patienten sollten daher regelmäßig auf Zeichen für eine Nephritis untersucht (eGFR, Urinsediment, Proteinurie) und zur Diagnosesicherung und Therapiesteuerung nierenbiopsiert werden.

Therapie

Die Therapie besteht aus Immunsuppressiva (Mycophenolat-Mofetil/Azathioprin/Cyclophosphamid) und „Lupus-Modifier“ (Hydroxychloroquin, Belimumab), um eine kortisonfreie Langzeitremission zu erzielen. Die begleitende Patientenschulung ist hierbei ein wichtiger Bestandteil für die Frühdiagnose eines erneuten Schubes und die Adhärenz der Therapie.

Ausblick

Ausgehend von neuen Einblicken in beteiligte molekulare Pathomechanismen, werden zurzeit zahlreiche neue Therapieansätze in klinischen Studien getestet, die den zumeist jungen erkrankten Frauen hoffnungsvolle Perspektiven bieten.

Abstract

Background

The clinical manifestations of systemic lupus erythematosus (SLE) vary depending on the organ systems affected. Lupus nephritis is associated with a poor prognosis; therefore, regular screening of SLE patients for renal involvement is mandatory with estimated glomerular filtration rate (eGFR), urinary sediment and proteinuria. A renal biopsy should be performed for diagnostics and treatment decisions.

Therapy

Treatment is based on the combination of immunosuppressive drugs, such as mycophenolate mofetil, azathioprine and cyclophosphamide and the so-called lupus modifiers (e.g. hydroxychloroquine and belimumab) to achieve long-term steroid-free remission. The accompanying patient education is an essential component for early detection of a flare and adherence to treatment.

Perspective

Based on novel insights into the molecular pathophysiology of SLE numerous clinical studies are currently ongoing to improve the therapy of the predominantly young female patients.

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Authors and Affiliations

  1. Schwerpunkt Rheumatologie und Klinische Immunologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    A. Schwarting

  2. ACURA Rheumazentrum Rheinland-Pfalz, Bad Kreuznach, Deutschland

    A. Schwarting

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A. Schwarting gibt an, Honorare für Vorträge von der Firma GSK erhalten zu haben.

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Schwarting, A. Lupusnephritis. Nephrologe 11, 134–141 (2016). https://doi.org/10.1007/s11560-016-0047-4

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