Resumen
Introduction: Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE). Primarily affecting women and carrying a six-fold higher mortality rate than the general population. LN's immunopathology involves immune complex deposition in the glomeruli, and its histopathological classification is primarily based on renal biopsy. Objectives: To assess the efficacy and safety of available treatments for LN in adults and identify emerging interventions for its management. Methods: A systematic review was conducted following PRISMA guidelines, including studies published up to January 2024. Searches were conducted in PubMed, the Cochrane Library, and Google Scholar, with two reviewers responsible for selection and data extraction, assessing the risk of bias in randomized controlled trials (RCTs) using the Cochrane tool. Results: A total of 212 articles were reviewed, 31 duplicates and 35 deemed irrelevant were eliminated. From the remaining 146, those with design flaws, inappropriate objectives, or inadequate population were excluded, leaving 31 articles meeting inclusion criteria, including 21 analytical studies and 10 RCTs. Discussion: Immunosuppressive therapy is recommended for LN class III and IV, while for class I or II, glucocorticoids with other immunosuppressive agents are recommended if nephrotic syndrome or proteinuria in the nephrotic range is present. In refractory cases, emerging therapies, such as guselkumab, offer new perspectives. Ensuring adequate treatment adherence is crucial to maximize therapeutic outcomes in these cases. Conclusions: The importance of reducing proteinuria is emphasized in LN management, with hydroxychloroquine (HCQ) recommended for these patients. Different immunosuppressive treatments are suggested based on the class of nephritis. Safe withdrawal of immunosuppression poses a challenge, requiring close evaluation and monitoring to avoid risks of renal flares.
Citas
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