European consensus statement on the terminology used in the management of lupus glomerulonephritis

Abstract

Systemic lupus erythematosus (SLE) is a complex, multisystem autoimmune disorder, which often involves referral to multiple medical specialists. Lupus nephritis (LN) occurs in ~35% of adults with SLE and predicts poor survival. There is currently no consensus on how to manage patients with SLE or LN across specialties and across different European countries. The Lupus Nephritis Terminology Advisory Group was formed to address this issue as it impacts upon LN treatment. It has developed consensus statements based on opinions from expert panel meetings with nephrologists, nephropathologists, rheumatologists, clinical immunologists and internal medicine specialists from many European countries, after reviewing current guidelines from the European League Against Rheumatism, the American College of Rheumatology and the participants’ experience. In this article, we report consensus statements that were developed in six important areas: classification of patients with LN, how classification affects the selection of treatment options and definitions of induction, response, flare and maintenance. We have also proposed a consensus for the terminology involved in the management of LN that is consistent with clinical opinion gathered from multidisciplinary expert meetings and with existing guidelines. We believe this consensus approach provides agreed expert opinion to clinicians and will form the basis for optimising LN treatment.

Keywords

European consensus statement lupus nephritis terminology

Get full access to this article

View all access options for this article.

References

1 Wallace DJ Podell TE Weiner JM . Lupus nephritis. Experience with 20 patients in a private practice from 1950 to 1980. Am J Med 1982; 72: 209–220.

2 Huong DL Papo T Beaufils H . Renal involvement in systemic lupus erythematosus. A study of 180 patients from a single centre. Medicine (Baltimore) 1999; 78: 148–166.

3 Font J Ramos-Casals M Cervera R . Cardiovascular risk factors and the long-term outcome of lupus nephritis. QJM 2001; 94: 19–26.

4 Waldman M Appel GB . Update on the treatment of lupus nephritis. Kidney Int 2006; 70: 1403–1412.

5 Mok CC . Therapeutic options for resistant lupus nephritis. Semin Arthritis Rheum 2006; 36: 71–81.

6 Bertsias GK Ioannidis JP Boletis J . EULAR recommendations for the management of systemic lupus erythematosus (SLE). Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 2008; 67: 195–205.

7 Bertsias GK Ioannidis JP Boletis J . Evidence for selection of end-points for clinical trials in systemic lupus erythematosus (SLE): a systematic literature review. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2008; Epub ahead of print.

8 Gordon C Bertsias GK Ioannidis JP . EULAR recommendations for points to consider in conducting clinical trials in systemic lupus erythematosus (SLE). Ann Rheum Dis 2008; Epub ahead of print.

9 Renal Disease Subcommittee of the American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria . The American College of Rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials. Arthritis Rheum 2006; 54: 421–432.

10.

10 Hay EM Bacon PA Gordon C . The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus. Q J Med 1993; 86: 447–458.

11.

11 Isenberg DA Gordon C . BILAG Group. British Isles Lupus Assessment Group. From BILAG to BLIPS–disease activity assessment in lupus past, present and future. Lupus 2000; 9: 651–654.

12.

12 Bombadier C Gladman DD Urowitz MB Caron D Change CH . Derivation of the SLEDAI. A disease activity index for lupus patients. The committee on prognosis studies in SLE. Arthritis Rheum 1992; 35: 630–640.

13.

13 Hawker G Gabriel S Bombadier C Goldsmith C Caron D Gladman D . A reliability study of SLEDAI: a disease activity index for systematic lupus erythematosus. J Rheumatol 1993; 20: 657–660.

14.

14 Gladman DD Urowitz MB Goldsmith CH . The reliability of the systemic international collaborating clinics/American college of rheumatology damage index in patients with systemic lupus erythematosus. Arthritis Rheum 1997; 40: 809–813.

15.

15 Gladman DD Goldsmith CH Urowitz MB . The systemic lupus international collaborating clinics/American college of rheumatology (SLICC/ACR) damage index for systemic lupus erythematosus international comparison. J Rheumatol 2000; 27: 373–376.

16.

16 Tan EM Cohen AS Fries JF . The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271–1277.

17.

17 Hochberg MC . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725.

18.

18 Weening JJ D'Agati VD Schwartz MM . The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004; 65: 521–530.

19.

19 American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines . Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis Rheum 1999; 42: 1785–1796.

20.

20 Houssiau FA Vasconcelos C D'Cruz D . 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: 2121–2131.

21.

21 Houssiau F . Thirty years of cyclophosphamide: assessing the evidence. Lupus 2007; 16: 212–216.

22.

22 Gourley MF Austin HA Scott D . Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern med 1996; 125: 549–557.

23.

23 Ginzler EM Dooley MA Aranow C . Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med 2005; 353: 2219–2228.

24.

24 Borba EF Guedes LK Christmann RB Figueiredo CP Gonçalves CR Bonfá E . Mycophenolate mofetil is effective in reducing lupus glomerulonephritis proteinuria. Rheumatol Int 2006; 26: 1078–1083.

25.

25 Appel GB Dooley MA Ginzler EM . Mycophenolate Mofetil Compared with Intravenous Cyclophosphamide as Induction Therapy for Lupus Nephritis: Aspreva Lupus Management Study (ALMS) Results. Abstract presented at The American Society of Nephrology 2007, San Francisco, California, USA. Abstract SA-FC057.

26.

26 Mok CC Ying KY Tang S . Predictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis. Arthritis Rheum 2004; 50: 2559–2568.