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Nefrite lúpica : revisão
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A nefrite lúpica surge como uma complicação do lúpus eritematoso sistémico num grande número de indivíduos, mesmo naqueles sem manifestações clínicas de doença renal. A avaliação da função renal nos indivíduos com lúpus eritematoso sistémico é importante pois permite, em muitos casos, a deteção e tratamento precoce, melhorando significativamente o prognóstico da nefrite lúpica.
A biópsia renal deve ser equacionada em qualquer pessoa com lúpus eritematoso sistémico e evidência clínica ou laboratorial de nefrite ativa.
O tratamento da nefrite lúpica varia consoante as características histológicas das lesões e tem como principal objetivo a normalização da função renal ou, pelo menos, impedir a sua progressiva deterioração. A terapêutica imunossupressora está indicada na vasta maioria dos indivíduos com nefrite lúpica proliferativa (classes III e IV) e em alguns casos de nefrite lúpica membranosa (classe V), incluindo aqueles com síndrome nefrótico grave, creatininemia elevada e/ou doença proliferativa associada. A terapêutica imunossupressora geralmente não é indicada para os casos de nefrite lúpica mesangial mínima (classe I) e proliferativa mesangial (classe II).
Esta revisão irá abordar vários aspetos da nefrite lúpica, incluindo os seus mecanismos de doença, a classificação da gravidade, o diagnóstico e prognóstico. Serão também analisadas as atuais abordagens terapêuticas e efeitos colaterais comuns.
Lupus nephritis arises as a complication of systemic lupus erythematosus in a large number of patients, even those without clinical signs of kidney disease. The assessment of renal function in patients with systemic lupus erythematosus is important because it allows in many cases, early detection and treatment, significantly improving the prognosis of lupus nephritis. Kidney biopsy should be considered in any patient with systemic lupus erythematosus and clinical or laboratory evidence of active nephritis. Treatment depends on the characteristics of the lupus nephritis histological lesions and aims to the normalization of renal function or at least the prevention of its progressive deterioration. Immunosuppressive therapy is indicated in the vast majority of patients with proliferative lupus nephritis (class III and IV) and in some cases of membranous lupus nephritis (class V), including those with severe nephrotic syndrome, elevated serum creatinine and/or associated proliferative disease. Immunosuppressive therapy is usually not indicated for cases of minimal mesangial (class I) and mesangial proliferative (class II) lupus nephritis. This review will address various aspects of lupus nephritis, including its disease mechanisms, classification, diagnosis and prognosis. The current therapeutic approaches and common side effects will also be examined.
Lupus nephritis arises as a complication of systemic lupus erythematosus in a large number of patients, even those without clinical signs of kidney disease. The assessment of renal function in patients with systemic lupus erythematosus is important because it allows in many cases, early detection and treatment, significantly improving the prognosis of lupus nephritis. Kidney biopsy should be considered in any patient with systemic lupus erythematosus and clinical or laboratory evidence of active nephritis. Treatment depends on the characteristics of the lupus nephritis histological lesions and aims to the normalization of renal function or at least the prevention of its progressive deterioration. Immunosuppressive therapy is indicated in the vast majority of patients with proliferative lupus nephritis (class III and IV) and in some cases of membranous lupus nephritis (class V), including those with severe nephrotic syndrome, elevated serum creatinine and/or associated proliferative disease. Immunosuppressive therapy is usually not indicated for cases of minimal mesangial (class I) and mesangial proliferative (class II) lupus nephritis. This review will address various aspects of lupus nephritis, including its disease mechanisms, classification, diagnosis and prognosis. The current therapeutic approaches and common side effects will also be examined.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Nefrite lúpica Lúpus eritematoso sistémico Indução Manutenção