Based On The Update Of The New KDIGO Guidelines, An Analysis Of The Status Quo Of Diagnosis And Treatment Of Lupus Nephritis in China
May 05, 2023
Lupus nephritis (LN) is the most common complication of systemic lupus erythematosus (SLE), and nearly half of SLE patients in China are complicated by LN. The main manifestations of LN are hematuria, proteinuria, edema, hypertension, and renal insufficiency. The complete remission rate of proliferative lupus nephritis with the existing induction therapy is low, and lupus nephritis is prone to recurrence.
Click to cistanche tubulosa Australia for nephritis
Therefore, it is very important to diagnose and treat lupus nephritis scientifically and standardized. During the 26th National Rheumatology Academic Conference, Professor Ye Shuang from Renji Hospital Affiliated with Shanghai Jiaotong University School of Medicine started with the update of the new Kidney Disease Outcomes Global Organization (KDIGO) guidelines, aiming at the diagnosis and treatment status of Lupus nephritis in China Discuss with management.
Expert Profile
Professor Ye Shuang
Director of Rheumatology Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine
Member of the Chinese Society of Rheumatology and the Rheumatology Branch of the Chinese Medical Doctor Association
Vice Chairman of the Rheumatic Immunology Branch of the China Medical Promotion Association
Member of the Standing Committee of ILD Multidisciplinary Committee of China Research Hospital Association
Vice Chairman of the Rheumatic Immunology Branch of the Chinese Geriatric Health Care Research Association
Vice President of the Internal Medicine Branch of the Shanghai Medical Doctor Association
Head of the Rheumatology Alliance of Shanghai Shenyang Municipal Hospital
Member of the Internal Medicine Branch and Rheumatism Branch of the Shanghai Medical Association
Published more than 80 SCI papers including NEJM, Lancet ID, Lancet Rheumatology, ARD, and A&R, and won the title of Shanghai Medical Craftsman
The new version of the KDIGO guideline is heavily updated, and new biological agents are included in the treatment of hyperplastic LN
In March 2023, KDIGO released the draft of clinical practice guidelines for LN treatment, summarizing and updating the data of randomized follow-up studies published since February 2022, and updating the existing LN treatment plan.
The update of the KDIGO guideline has provided important guidance for clinical practice in all aspects of LN diagnosis and treatment. Among them, the update of initial treatment and maintenance treatment of hyperplastic LN is particularly eye-catching.
The new version of the guideline adds new opinions, recommending that active type III/IV LN, whether with or without membranous LN, should be treated with glucocorticoids combined with any of the following regimens for induction treatment:
➤Mycophenolic acid analogs (MPAA); or
➤Low-dose IV cyclophosphamide; or
➤Belimumab plus MPAA or low-dose IV cyclophosphamide; or
➤When the renal function is not severely impaired (severely impaired such as eGFR≤45ml/min/1.73m2), MPAA is combined with calcineurin inhibitor (CNI).
In addition, in the relevant practice points, the guideline gives feasible suggestions for different patients. For patients with active III/IV LN who cannot tolerate oral regimens, intravenous cyclophosphamide is recommended as initial treatment; for patients with proliferative LN who are at high risk of infertility, if they have previously For patients with a history of renal failure, it is recommended to choose an MPAA-based treatment plan for initial treatment; for patients with a high risk of renal recurrence or progression of renal failure, the triple therapy of belimumab + steroid + MPAA/reduced cyclophosphamide may be considered. In general, new biologics and non-biologics therapies in the field of LN are under development. For example, rituximab may be considered in patients who remain active or do not respond well to initial conventional therapy.
For the maintenance treatment of type III/IV LN, the new guidelines recommend that after the initial treatment, patients should continue to use MPAA maintenance treatment. During maintenance therapy, corticosteroids should be gradually reduced to the lowest possible dose, unless extrarenal lupus manifestations can be used; after the patient maintains complete clinical remission of the kidney for ≥12 months, discontinuation of corticosteroids can be considered. In addition, in addition to conventional treatment, patients receiving triple immunosuppressive regimens including belimumab or CNI can continue to use triple immunosuppressive regimens as maintenance therapy.
It is not difficult to see that the update of this guideline is highly based on clinical evidence-based updates, reducing the use of hormones as much as possible, and combining new treatment options such as biological agents as soon as possible are the key points of the guideline update. The update of these points has further promoted the development of LN. Standardization of treatment.
Individualized treatment and precise treatment are still the top priority of LN management
Looking at the current situation of LN in China, the incidence rate is high, the recurrence rate is high, and the long-term survival is not good. Over the past few decades, with the continuous optimization of treatment options, the remission rate of Chinese LN patients has continued to increase. However, the long-term renal outcome of Chinese LN patients is still not optimistic, and the 20-year renal survival rate is low.
Moreover, compared with SLE patients without renal involvement, the proportion of hormones and immunosuppressants used in LN patients is significantly higher, and long-term use of these traditional treatment options will cause long-term organ damage to patients, leading to frequent adverse reactions such as infection and affecting prognosis.
Therefore, how to formulate an individualized treatment plan, while controlling the disease, reduce the dosage of hormones as soon as possible in the LN induction remission and maintenance treatment plan, reduce recurrence, delay the progression of renal damage, and improve the prognosis of patients is the focus of LN management.
In recent years, new drugs have emerged in the field of LN in China, and new biological agents represented by belimumab have been continuously upgraded in the treatment of LN, bringing more treatment options for patients.
The BLISS-LN study is a global, multicenter RCT study of belimumab in the treatment of LN. The study lasted for 2 years, aiming to evaluate the efficacy and safety of belimumab in adult patients with active LN confirmed by renal biopsy sex.
Studies have shown that belimumab combined with conventional treatment can further increase the renal remission rate of LN patients and reduce the dosage of hormones, which can bring multiple benefits to LN patients. It is expected that more new therapeutic drugs will be applied in clinical practice as soon as possible to bring good news to patients.
The mechanism of Cistanche extract treating kidney disease
Cistanche extract is a traditional Chinese medicine used for the treatment of various diseases, including kidney disease. The mechanism of action of Cistanche extract in treating kidney disease involves several factors.
1. Anti-inflammatory properties: Cistanche extract contains natural compounds that have anti-inflammatory properties. These compounds help to reduce inflammation in the kidneys, which can reduce the damage caused by kidney disease.
2. Antioxidant properties: Cistanche extract also contains antioxidants that help to protect the kidneys from oxidative stress. Oxidative stress occurs when there is an imbalance between free radicals and antioxidants in the body. This can damage the kidneys and contribute to the development of kidney disease.
3. Renal function improvement: Cistanche extract has been found to improve renal function in animal studies. It can help to reduce proteinuria, which is a common symptom of kidney disease, and also reduce the levels of serum creatinine and blood urea nitrogen (BUN), which are markers of kidney function.
4. Immune system modulation: Cistanche extract can help to modulate the immune system, which can reduce the progression of kidney disease. In particular, it can help to regulate T cell activity, which can reduce inflammation in the kidneys and improve renal function.
Overall, the use of Cistanche extract in the treatment of kidney disease is promising.
