Волчаночный нефрит в XXI веке

Бобкова И.Н., Моисеев С.В., Лысенко Л.В., Камышова Е.С. Волчаночный нефрит в XXI веке. Терапевтический архив. 2022;94(6):713–717. DOI: 10.26442/00403660.2022.06.201559

________________________________________________

Bobkova IN, Moiseev SV, Lysenko LV, Kamyshova ES. Lupus nephritis in the XXI century. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(6):713–717. DOI: 10.26442/00403660.2022.06.201559

Читать PDF

Аннотация

Волчаночный нефрит (ВН) – наиболее частое органное поражение при системной красной волчанке (СКВ), развивающееся у 40–50% пациентов. Благодаря иммуносупрессивной терапии выживаемость больных СКВ за последние 50 лет значительно увеличилась, а доля тяжелого поражения почек в структуре причин смерти уменьшилась. Тем не менее рецидивы ВН, осложнения иммуносупрессии, ускоренный атерогенез и сопутствующие заболевания способствуют накоплению повреждения органов и увеличению риска смерти. В статье рассмотрено место поражения почек в клинической картине СКВ, а также факторы риска развития ВН и основные гистопатологические изменения в почках, обозначен ряд вопросов, решение которых необходимо для оптимизации лечения и улучшения отдаленных исходов ВН, в том числе вопрос об изменении схем патогенетической терапии с ограничением приема глюкокортикоидов и назначением препаратов со стероидосберегающей активностью, внедрение новых генно-инженерных биологических препаратов для лечения ВН и более широкое использование современных возможностей нефропротекции.

Ключевые слова: волчаночный нефрит, эпидемиология, смертность, классификация

________________________________________________

Lupus nephritis (LN) is the most common organ lesion in systemic lupus erythematosus (SLE), developing in 40–50% of patients. Due to immunosuppressive therapy, the survival of patients with SLE has increased significantly over the past 50 years, and the proportion of severe kidney damage in the death structure has decreased. However, LN relapses and complications of immunosuppression, accelerated atherogenesis, concomitant diseases lead to the accumulation of organ damage and an increased risk of death. The article consideres the place of kidney damage in the SLE, the risk factors for LN development, the main renal histopathological changes, it identifies a number of issues that need to be addressed to optimize treatment and improve LN long-term outcomes, including, the revision of pathogenetic therapy regimens with restriction of glucocorticosteroids and prescribing drugs with steroid-sparing activity, the integration of new drugs for LN treatment, wider use of modern nephroprotection capabilities.

Keywords: lupus nephritis, epidemiology, mortality, classification

Полный текст

Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis. 2020;79(6):713-23. DOI:10.1136/annrheumdis-2020-216924
2. Hanly JG, O'Keeffe AG, Su L, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford). 2016;55(2):252-62. DOI:10.1093/rheumatology/kev311
3. Parikh SV, Almaani S, Brodsky S, Rovin BH. Update on Lupus Nephritis: Core Curriculum 2020. Am J Kidney Dis. 2020;76(2):265-81. DOI:10.1053/j.ajkd.2019.10.017
4. Kon T, Yamaji K, Sugimoto K, et al. Investigation of pathological and clinical features of lupus nephritis in 73 autopsied cases with systemic lupus erythematosus. Mod Rheumatol. 2010;20(2):168-77. DOI:10.1007/s10165-009-0260-3
5. Borchers AT, Leibushor N, Naguwa SM, et al. Lupus nephritis: a critical review. Autoimmun Rev. 2012;12(2):174-94. DOI:10.1016/j.autrev.2012.08.018
6. Rovin BH, Parikh SV, Alvarado A. The kidney biopsy in lupus nephritis: is it still relevant? Rheum Dis Clin North Am. 2014;40(3):537-ix. DOI:10.1016/j.rdc.2014.04.004
7. Остапенко В.М. Из истории изучения системной красной волчанки (вклад академика АМН СССР Е.М. Тареева и его клинической школы). Научно-практическая ревматология. 2004;42(1):94-7 [Ostapenko V.M. From history of systemic lupus erythematosus study (Contribution of E.M. Tareev and his clinical school). Rheumatology Science and Practice. 2004;42(1):94-7 (in Russian)].
8. Основы нефрологии. Под ред. Е.М. Тареева. М.: Медицина, 1972. Т. 2; с. 595-634 [Osnovy nefrologii. Pod red. EM Tareeva. Moscow: Meditsina, 1972. T. 2; s. 595-634 (in Russian)].
9. Almaani S, Meara A, Rovin BH. Update on Lupus Nephritis. Clin J Am Soc Nephrol. 2017;12(5):825-35. DOI:10.2215/CJN.05780616
10. Моисеев С.В., Новиков П.И., Буланов Н.М. Системная красная волчанка: эпидемиология, отдаленные исходы и бремя болезни. Клин. фармакология и терапия. 2021;30(4):13-22 [Moiseev S, Novikov P, Bulanov N. Systemic lupus erythematosus: epidemiology, outcomes and burden. Klinicheskaya farmakologiya i terapiya = Clin Pharmacol Ther. 2021;30(4):13-22 (in Russian)]. DOI:10.32756/ 0869-5490-2021-4-13-22
11. Barber MRW, Drenkard C, Falasinnu T, et al. Global epidemiology of systemic lupus erythematosus. Nat Rev Rheumatol. 2021;17(9):515-32. DOI:10.1038/s41584-021-00668-1
12. Salmon JE, Millard S, Schachter LA, et al. Fc gamma RIIA alleles are heritable risk factors for lupus nephritis in African Americans. J Clin Invest. 1996;97(5):1348-54. DOI:10.1172/JCI118552
13. Munroe ME, James JA. Genetics of Lupus Nephritis: Clinical Implications. Semin Nephrol. 2015;35(5):396-409. DOI:10.1016/j.semnephrol.2015.08.002
14. Iwamoto T, Niewold TB. Genetics of human lupus nephritis. Clin Immunol. 2017;185:32-9. DOI:10.1016/j.clim.2016.09.012
15. Davidson A, Aranow C, Mackay M. Lupus nephritis: challenges and progress. Curr Opin Rheumatol. 2019;31(6):682-8. DOI:10.1097/BOR.0000000000000642
16. Tektonidou MG, Lewandowski LB, Hu J, et al. Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016. Ann Rheum Dis. 2017;76(12):2009-16. DOI:10.1136/annrheumdis-2017-211663
17. Moroni G, Vercelloni PG, Quaglini S, et al. Changing patterns in clinical-histological presentation and renal outcome over the last five decades in a cohort of 499 patients with lupus nephritis. Ann Rheum Dis. 2018;77(9):1318-25. DOI:10.1136/annrheumdis-2017-212732
18. Tektonidou MG, Dasgupta A, Ward MM. Risk of End-Stage Renal Disease in Patients With Lupus Nephritis, 1971–2015: A Systematic Review and Bayesian Meta-Analysis. Arthritis Rheumatol. 2016;68(6):1432-41. DOI:10.1002/art.39594
19. Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int. 2004;65(2):521-30.
DOI:10.1111/j.1523-1755.2004.00443.x
20. Rovin BH, Caster DJ, Cattran DC, et al. Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;95(2):281-95. DOI:10.1016/j.kint.2018.11.008
21. Bajema IM, Wilhelmus S, Alpers CE, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018;93(4):789-96. DOI:10.1016/j.kint.2017.11.023
22. Dall'Era M. Treatment of lupus nephritis: current paradigms and emerging strategies. Curr Opin Rheumatol. 2017;29(3):241-7. DOI:10.1097/BOR.0000000000000381
23. Houssiau FA, Vasconcelos C, D'Cruz D, et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum. 2002;46(8):2121-31. DOI:10.1002/art.10461
24. Appel GB, Contreras G, Dooley MA, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol. 2009;20(5):1103-12. DOI:10.1681/ASN.2008101028
25. Illei GG, Takada K, Parkin D, et al. Renal flares are common in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy: long-term followup of a cohort of 145 patients participating in randomized controlled studies. Arthritis Rheum. 2002;46(4):995-1002. DOI:10.1002/art.10142
26. Houssiau FA, D'Cruz D, Sangle S, et al. Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis. 2010;69(12):2083-9. DOI:10.1136/ard.2010.131995
27. Dooley MA, Jayne D, Ginzler EM, et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2011;365(20):1886-95. DOI:10.1056/NEJMoa1014460
28. Shin JI, Li H, Park S, et al. Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses. J Clin Med. 2022;11(2):343. DOI:10.3390/jcm11020343
29. Bankole AA, Nwaonu JN. The Shifting Landscape of Lupus Nephritis Management: A Review. Cureus. 2022;14(1):e20950. DOI:10.7759/cureus.2095
30. Morales E, Galindo M, Trujillo H, Praga M. Update on Lupus Nephritis: Looking for a New Vision. Nephron. 2021;145(1):1-13. DOI:10.1159/000511268

________________________________________________

1. Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis. 2020;79(6):713-23. DOI:10.1136/annrheumdis-2020-216924
2. Hanly JG, O'Keeffe AG, Su L, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford). 2016;55(2):252-62. DOI:10.1093/rheumatology/kev311
3. Parikh SV, Almaani S, Brodsky S, Rovin BH. Update on Lupus Nephritis: Core Curriculum 2020. Am J Kidney Dis. 2020;76(2):265-81. DOI:10.1053/j.ajkd.2019.10.017
4. Kon T, Yamaji K, Sugimoto K, et al. Investigation of pathological and clinical features of lupus nephritis in 73 autopsied cases with systemic lupus erythematosus. Mod Rheumatol. 2010;20(2):168-77. DOI:10.1007/s10165-009-0260-3
5. Borchers AT, Leibushor N, Naguwa SM, et al. Lupus nephritis: a critical review. Autoimmun Rev. 2012;12(2):174-94. DOI:10.1016/j.autrev.2012.08.018
6. Rovin BH, Parikh SV, Alvarado A. The kidney biopsy in lupus nephritis: is it still relevant? Rheum Dis Clin North Am. 2014;40(3):537-ix. DOI:10.1016/j.rdc.2014.04.004
7. Ostapenko V.M. From history of systemic lupus erythematosus study (Contribution of E.M. Tareev and his clinical school). Rheumatology Science and Practice. 2004;42(1):94-7 (in Russian).
8. Osnovy nefrologii. Pod red. EM Tareeva. Moscow: Meditsina, 1972. T. 2; s. 595-634 (in Russian).
9. Almaani S, Meara A, Rovin BH. Update on Lupus Nephritis. Clin J Am Soc Nephrol. 2017;12(5):825-35. DOI:10.2215/CJN.05780616
10. Moiseev S, Novikov P, Bulanov N. Systemic lupus erythematosus: epidemiology, outcomes and burden. Klinicheskaya farmakologiya i terapiya = Clin Pharmacol Ther. 2021;30(4):13-22 (in Russian). DOI:10.32756/ 0869-5490-2021-4-13-22
11. Barber MRW, Drenkard C, Falasinnu T, et al. Global epidemiology of systemic lupus erythematosus. Nat Rev Rheumatol. 2021;17(9):515-32. DOI:10.1038/s41584-021-00668-1
12. Salmon JE, Millard S, Schachter LA, et al. Fc gamma RIIA alleles are heritable risk factors for lupus nephritis in African Americans. J Clin Invest. 1996;97(5):1348-54. DOI:10.1172/JCI118552
13. Munroe ME, James JA. Genetics of Lupus Nephritis: Clinical Implications. Semin Nephrol. 2015;35(5):396-409. DOI:10.1016/j.semnephrol.2015.08.002
14. Iwamoto T, Niewold TB. Genetics of human lupus nephritis. Clin Immunol. 2017;185:32-9. DOI:10.1016/j.clim.2016.09.012
15. Davidson A, Aranow C, Mackay M. Lupus nephritis: challenges and progress. Curr Opin Rheumatol. 2019;31(6):682-8. DOI:10.1097/BOR.0000000000000642
16. Tektonidou MG, Lewandowski LB, Hu J, et al. Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016. Ann Rheum Dis. 2017;76(12):2009-16. DOI:10.1136/annrheumdis-2017-211663
17. Moroni G, Vercelloni PG, Quaglini S, et al. Changing patterns in clinical-histological presentation and renal outcome over the last five decades in a cohort of 499 patients with lupus nephritis. Ann Rheum Dis. 2018;77(9):1318-25. DOI:10.1136/annrheumdis-2017-212732
18. Tektonidou MG, Dasgupta A, Ward MM. Risk of End-Stage Renal Disease in Patients With Lupus Nephritis, 1971–2015: A Systematic Review and Bayesian Meta-Analysis. Arthritis Rheumatol. 2016;68(6):1432-41. DOI:10.1002/art.39594
19. Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int. 2004;65(2):521-30.
DOI:10.1111/j.1523-1755.2004.00443.x
20. Rovin BH, Caster DJ, Cattran DC, et al. Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;95(2):281-95. DOI:10.1016/j.kint.2018.11.008
21. Bajema IM, Wilhelmus S, Alpers CE, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018;93(4):789-96. DOI:10.1016/j.kint.2017.11.023
22. Dall'Era M. Treatment of lupus nephritis: current paradigms and emerging strategies. Curr Opin Rheumatol. 2017;29(3):241-7. DOI:10.1097/BOR.0000000000000381
23. Houssiau FA, Vasconcelos C, D'Cruz D, et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum. 2002;46(8):2121-31. DOI:10.1002/art.10461
24. Appel GB, Contreras G, Dooley MA, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol. 2009;20(5):1103-12. DOI:10.1681/ASN.2008101028
25. Illei GG, Takada K, Parkin D, et al. Renal flares are common in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy: long-term followup of a cohort of 145 patients participating in randomized controlled studies. Arthritis Rheum. 2002;46(4):995-1002. DOI:10.1002/art.10142
26. Houssiau FA, D'Cruz D, Sangle S, et al. Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis. 2010;69(12):2083-9. DOI:10.1136/ard.2010.131995
27. Dooley MA, Jayne D, Ginzler EM, et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2011;365(20):1886-95. DOI:10.1056/NEJMoa1014460
28. Shin JI, Li H, Park S, et al. Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses. J Clin Med. 2022;11(2):343. DOI:10.3390/jcm11020343
29. Bankole AA, Nwaonu JN. The Shifting Landscape of Lupus Nephritis Management: A Review. Cureus. 2022;14(1):e20950. DOI:10.7759/cureus.2095
30. Morales E, Galindo M, Trujillo H, Praga M. Update on Lupus Nephritis: Looking for a New Vision. Nephron. 2021;145(1):1-13. DOI:10.1159/000511268

Авторы

И.Н. Бобкова*, С.В. Моисеев, Л.В. Лысенко, Е.С. Камышова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*irbo.mma@mail.ru

________________________________________________

Irina N. Bobkova*, Sergey V. Moiseev, Lidia V. Lysenko, Elena S. Kamyshova

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*irbo.mma@mail.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.