CLINICAL AND MORPHOLOGICAL CHARACTERISTICS AND EFFECTIVENESS OF TREATMENT OF PATIENTS WITH LUPUS NEPHRITIS (EXPERIENCE OF ONE CENTER)

Background. Lupus nephritis is one of the most severe manifestations of systemic lupus erythematosus, which negatively affects the prognosis of the disease. In case of delayed diagnosis and treatment, it leads to unfavorable outcomes of renal survival.

Aim. Determine the clinical and morphological characteristics and analyze the effectiveness of treatment of patients with lupus nephritis in the Irkutsk Nephrological Clinic.

Material and methods. Clinical and morphological characteristics of patients with lupus glomerulonephritis were carried out in the general group of patients (n = 40). The diagnosis of systemic lupus erythematosus was established using the criteria of EULAR/ACR, 2019. The diagnosis of lupus glomerulonephritis was based on the detection of characteristic clinical and laboratory data and the results of morphological examination of renal tissue. The effectiveness of standard induction therapy was evaluated in a sample group of patients (n = 20). Clinical symptoms and laboratory parameters were compared before and after 3 months of induction therapy with corticosteroids and cyclophosphamide.

Results. Clinical and laboratory symptoms of lupus nephritis are characterized by nephrotic syndrome (in 70 % of patients), hematuria (100 %), arterial hypertension (75 %); almost half of patients have decreased renal function. Morphological examination of renal tissue reveals the prevalence of lupus nephritis of class IV (66.7 %), including with half-moons in 58.3 % of patients, with “full house" (13 %) and with acute tubular necrosis (47.8 %). An analysis of the effectiveness of induction therapy in the first 3 months found a significant decrease in proteinuria and improvement in renal function only in patients without half moons or with half moons in less than 50 % of glomeruli compared with patients with half moons in more than 50 % of glomeruli.

Conclusion. Patients with systemic lupus erythematosus and renal impairment most often develop lupus glomerulonephritis of class IV. The predominant clinical manifestation of lupus nephritis class IV is nephrotic syndrome. Half of the patients have renal insufficiency. To improve the effectiveness of treatment of patients with rapidly progressing semilunar glomerulonephritis, it is advisable to use targeted immunosuppressants of a new generation.

1. Ассоциация нефрологов, Научное общество нефрологов России, Общероссийская общественная организация нефрологов «Российское диализное общество». Клинические рекомендации. Диагностика и лечение волчаночного нефрита. М.;2021 [Association of Nephrologists, Scientific Society of Nephrologists of Russia, All-Russian Public Organization of Nephrologists "Russian Dialysis Society". Clinical guidelines. Diagnosis and treatment of lupus nephritis. M.; 2021 (In Russian)]. URL: https://rusnephrology.org/wpcontent/uploads/2021/02/lupus.pdf [дата доступа: 22.10.2024]

2. Бобкова И.Н., Буланов Н.М., Захарова Е.В. и др. Клинические практические рекомендации KDIGO 2021 по лечению гломерулярных болезней. Нефрология и диализ. 2022;24(4):577-874 [Bobkova I.N., Bulanov N.M., Zakharova E.V. et al. KDIGO 2021 Clinical Practice Guideline for the Management of GLOMERULAR Diseases. Nephrology and Dialysis. 2022;24(4):577-874. (In Russian)]. DOI:10.28996/2618-9801-2022-4-577-874

3. Aringer M., Costenbader K., Daikh D. et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheum 2019;71(9):1400-1412. DOI: 10.1002/art.40930

4. Козловская Н.Л., Соловьев С.К., Асеева Е.А. и др. Обновленные рекомендации EULAR/ERA–EDTA 2019 г. по терапии волчаночного нефрита. Комментарии экспертов. Часть I. Современная ревматология. 2020;14(4):7–15. [Kozlovskaya N.L., Solovyov S.K., Aseeva E.A. et al. Updated recommendations EULAR/ERA–EDTA 2019 on the therapy of lupus nephritis. Expert comments. Part I. Modern Rheumatology. 2020;14(4):7-15 (In Russian)]. DOI: 10.14412/1996-7012- 2020-4-7-15

5. Danchenko N., Satia J.A., Anthony M.S. Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus. 2006;15(5):308-318. DOI: 10.1191/0961203306lu2305xx

6. Rovin B.H., Caster D.J., Cattran D.C. 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):281-295. DOI:10.1016/j.kint.2018.11.008

7. Dall'Era M., Cisternas M.G., Smilek D.E. et al. Predictors of long-term renal outcome in lupus nephritis trials: lessons learned from the Euro-Lupus Nephritis cohort. Arthritis Rheumatol. 2015;67:1305–1313. DOI: 10.1002/art.39026

8. Rijnink E.C., Teng Y.K.O., Kraaij T. et al. Validation of the Systemic Lupus International Collaborating Clinics classification criteria in a cohort of patients with

9. full house glomerular deposits. Kidney Int 2018;93:214-220. DOI: 10.1016/j.kint.2017.07.017

10. Rovin B.H., Ayoub I.M., Chan T.M. et al. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis. Kidney Int. 2024;105(1):31-34. DOI:10.1016/j.kint.2023.09.001

11. Моисеев С.В., Буланов Н.М. Лечение волчаночного нефрита. Клин фармакол тер 2024;33(3):6-13 [Moiseev S.V., Bulanov N.M. Treatment of lupus nephritis. Klini cheskaya farmakologiya i terapiya = Clin Pharmacol Ther 2024;33(3):6-13 (In Russian)]. DOI: 10.32756/0869-5490-2024-3-6-13.

12. Rovin B.H., Teng Y.K.O., Ginzler E.M. et al. Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2021;397:2070–2080. DOI: 10.1016/S0140-6736(21)00578-X

13. Furie R., Rovin B.H., Houssiau F. et al. Two-year, randomized, controlled trial of belimumab in lupus nephritis. N Engl J Med. 2020;383:1117–1128 DOI: 10.1056/NEJMoa2001180

14. Насонов Е.Л., Попкова Т.В., Лила А.М. Белимумаб в лечении системной красной волчанки: 20 лет фундаментальных исследований, 10 лет клинической практики. Научно-практическая ревматология. 2021;59(4):367–383 [Nasonov E.L., Popkova T.V., Lila A.M. Belimumab in the treatment of systemic lupus erythematosus: 20 years of basic research, 10 years of clinical practice. Nauchcno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2021;59(4):367–383 (In Russian)]. DOI: 10.47360/1995-4484-2021-367-383

15. Rovin B.H., Furie R., Teng Y.K.O. et al. A secondary analysis of the Belimumab International Study in Lupus Nephritis trial examined effects of belimumab on kidney outcomes and preservation of kidney function in patients with lupus nephritis. Kidney Int. 2022;101:403–413. DOI: 10.1016/j.kint.2021.08.027

16. Furie R., Rovin B.H., Houssiau F. et al. Safety and efficacy of belimumab in patients with lupus nephritis. Open-label extension of BLISS-LN study. Clin J Am Soc Nephrol. 2022;17:1620–1630. DOI: 10.2215/CJN.02520322