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Treatment Decisions in SLE Ahmed Elshebiny University of Menoufyia
General Principles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Plan General measures
Assessment of disease activity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of mortality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lupus Nephritis ,[object Object],[object Object],[object Object],[object Object]
Lupus Nephritis (pathophsiology) ,[object Object],[object Object]
Modified Classification of LN (Kumar and Clarks’s , Clinical Medicine 2009) Progressive renal failure Advanced sclerosing VI 10-20% of cases Good prognosis Membranous V Progression to NS, HTN, and Renal imp. Most common and most severe Diffuse LN IV 10-20% of cases Hematuria and proteinuria Focal LN III Mild renal disease Mesangial proliferative LN II A symptomatic Minimal mesangial LN I Clinical Histological  Class
Lupus nephritis ( CLINICALLY) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Renal biopsy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(E- Medicine, Rheumatology, Nephritis, Lupus,2009)
Biopsy spicimens
Biopsy specimens
Activity and Chronicity in Renal biopsy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Chronicity Index Activity index
Treatment of Lupus nephritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment of Lupus Nephritis base on biopsy Class Prepare for hemo which is better than peritoneal Arrange for renal Tx, treat extra-renal lupus VI Prednisone for 1-3 months followed by low dose for 1-2 years Azathioprin , chlorambucil, cyclophosphamide or MMF may decrease proteinuria V IV Prednisolone 1mg/kg/d for 1 month then taper depending on the clinical response to 5-10 mg for 2-2.5 years or Pulses for 3 days in severly ill add imunosupressive when indicated, adjust immunosupressine with cbc III 20-40 for 1 -3 months II Non specific I Treatment Clasas
Active Lupus Nephritis : Induction of remission   ,[object Object],[object Object],[object Object],Prospective controlled trials in active lupus nephritis show that administration of high doses of glucocorticoids (1000 mg of methylprednisolone daily for 3 days) by intravenous routes compared with daily oral routes shortens the time to maximal improvement by a few weeks but does not result in better renal function. It has become standard practice to initiate therapy for active, potentially life-threatening SLE with high-dose IV glucocorticoid pulses, based on studies in lupus nephritis. This approach must be tempered by safety considerations, such as the presence of conditions adversely affected by glucocorticoids (infection, hyperglycemia, hypertension, osteoporosis, etc .).  (Harrison online 2008)
Prognosis of Lupus glomerulonephritis ,[object Object],[object Object],(Kumar and Clarks’s , Clinical Medicine 2009)
Lupus cerebritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hematological abnormalities (cytopenias) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Current , Rheumatology)
Serositis ,[object Object],[object Object],[object Object],[object Object]
Cutaneous manifestations of Lupus
Uncommom features ,[object Object],[object Object]
Pregnancy and Lupus ,[object Object],[object Object],[object Object],[object Object]
Lupus+ Antiphospholipid syndrome ,[object Object]
Prednisolone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methylprednisolone ,[object Object],[object Object],[object Object]
Cyclophosphamide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MMF (Celcept) or Mycophenolic acid(Myfortic) ,[object Object],[object Object],[object Object]
Azathioprine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ciclosporin
Rutiximab
Plasmaphresis ,[object Object]
Hydroxychloroquin
References
THANK  YOU

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Treatment Decisions in SLE: Tailoring Care Based on Disease Activity and Damage

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  • 2. Treatment Decisions in SLE Ahmed Elshebiny University of Menoufyia
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  • 9. Modified Classification of LN (Kumar and Clarks’s , Clinical Medicine 2009) Progressive renal failure Advanced sclerosing VI 10-20% of cases Good prognosis Membranous V Progression to NS, HTN, and Renal imp. Most common and most severe Diffuse LN IV 10-20% of cases Hematuria and proteinuria Focal LN III Mild renal disease Mesangial proliferative LN II A symptomatic Minimal mesangial LN I Clinical Histological Class
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  • 16. Treatment of Lupus Nephritis base on biopsy Class Prepare for hemo which is better than peritoneal Arrange for renal Tx, treat extra-renal lupus VI Prednisone for 1-3 months followed by low dose for 1-2 years Azathioprin , chlorambucil, cyclophosphamide or MMF may decrease proteinuria V IV Prednisolone 1mg/kg/d for 1 month then taper depending on the clinical response to 5-10 mg for 2-2.5 years or Pulses for 3 days in severly ill add imunosupressive when indicated, adjust immunosupressine with cbc III 20-40 for 1 -3 months II Non specific I Treatment Clasas
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