Clinical response criteria of lupus nephritis according to current guidelines Guideline Complete Response Criteria Partial Response Criteria No Response KDIGO Decline in UPCR to ≤0.5 g/g >50% decrease in UPCR; if there Failure to achieve a complete or (≤50mg/mmol); return of Scr to was nephrotic-range proteinuria, then partial remission previous baseline reduction to <3,000 mg/g [<300 mg/ mmol] also; stabilization (±25%), or improvement of Scr, but no to normal ACR UPCR <0.2 g/g; normal Scr, or 25% UPCR of 0.2-2 g/g; eGFR at baseline No change or worsening improvement in eGFR if abnormal at level or improves 25% if abnormal at proteinuria; decline in eGFR by LN fare; inactive urine sediment LN fare; inactive urine sediment ≥25%; active urine sediment EULAR/ERA- UPCR <0.5 g/g; (50 mg/mmol); ≥50% reduction in UPCR, to less than <50% reduction in proteinuria or EDTA GFR within 10% of previous normal nephrotic range; near-normal GFR persistent nephrotic proteinuria; (within 10% of prior baseline) by 12 abnormal GFR (>10% decrease mo of treatment from prior baseline) Dutch SLE Proteinuria <0.5 g/24 h; Scr within Reduction in proteinuria by >50% to Persistent proteinuria with <50% Working Group 25% of baseline before fare <3 g/24 h; Scr within 25% of prior reduction or persistently >3g/24h baseline by 6-12 mo of treatment after 6-12 mo; doubling of Scr within 3 mo of starting therapy Abbreviations: ACR, American College of Rheumatology; eGFR, estimated glomerular fltration rate; EULAR/ERA-EDTA, European League Against Rheumatism/European Renal Association-European Dialysis and Transplant Association; GFR, glomerular fltration rate; KDIGO, Kidney Disease: Improvin Global Outcomes; LN, lupus nephritis; Scr, serum creatinine; SLE, Systemic lupus erythematosus; UPCR, urinary protein-creatinine ratio. Parikh SV, Almaani S, Brodsky S et al. Update on Lupus Nephritis: Core Curriculum 2020. Am J Kidney Dis. 2020 Aug;76(2):26. Epub 2020 Mar 24. חודשים נמצא כמדד הפרוגנוסטי היחיד הטוב ביותר לניבוי הדרדרות כליתית או הגעה לאי ספיקת כליות סופנית 12 פרוטאינוריה בבחולות עם לופוס נפריטיס. The Safety of Estrogen in Lupus Erythematosus National Assessment (SLENA) trial defnitions of fare 'mild/moderate fare' 'Severe fare' • a change in SLEDAI ≥3 points, or • change in SLEDAI >12, or • new/worse skin, stomatitis, serositis, arthritis, fever, or • new/worse CNS-SLE, vasculitis, nephritis, myositis, Plt < 60,000 hemolytic ane- • increased prednisone <0.5mg/kg/d, or mia with Hb <7 mg/dl, requiring doubling or >0.5 mg/kg/d prednisone, or • added NSAID/Plaquenil, or • hospitalization for SLE, or • ≥1.0 increase in a physician's global assessment (0-3 scale) • prednisone > 0.5 mg/kg/d, or • new immunosuppressive, or • increase in physician's global assessment to > 2.5 Petri M, Buyon J, Kim M. Classifcation and defnition of major fares in SLE clinical trials. Lupus. 1999;8(8):685-691. מדד פרקטי להערכה של התלקחות זאבת, בנוסף להערכה של רמת פעילותה. , בנוסף למספר פרמטרים פשוטים הנלקחים במרפאה כגון שינוי קליני, שינוי תרופתי והערכת הרופא המטפל SLEDAI המדד מורכב מ- .)0-3 (בסקאלה של Scoring of the British Isles Lupus Assessment Group (BILAG) E M Hay, P A Bacon, C Gordon et al. The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus. Q J Med 1993 Jul;86(7):447-58. Letter Defnition Categorization A Severe disease requiring increases in prednisone to >20 mg/day and/or the addition of immunosuppressive agents B LESS ACTIVE disease requiring low-dose prednisone and/or symptomatic treatment with NSAIDs and/or antimalarials C Mild disease requiring symptomatic therapy such as simple analgesics or stable disease on current therapy D Previous organ system involvement without current disease activity E No previous or current disease involvment in that organ system 29
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